Introduction: Radiotherapy alone or combined with surgery and/or chemotherapy is being investigated in the treatment of malignant pleural mesothelioma (MPM). This study aimed to simulate a Volumetric Modulated Arc Therapy (VMAT) treatment of a patient with MPM. Materials and Methods: CT images from a patient with intact lungs were imported via DICOM into the Pinnacle3 treatment planning (TP) system (TPS) and used as a model for MPM to delineate organs at risk (OAR) and both clinical and planning target volumes (CTV and PTV) with a margin of 5 mm. Elekta Synergy with 6 MV photons and 80 leafs MLCi2 was employed. VMAT plans were generated using two coplanar arcs with gantry rotation angles of 178° - 182°, the collimator angles of each arc were set to 90°, Octavius® 4D 729 was employed for quality assurance while the calculated and measured doses were compared using VeriSoft. Results: A TP was achieved. The Gamma volume analysis with criteria of 3 mm distance to agreement and 3% dose difference yielded the gamma passing rate = 99.9%. The reference isodose was 42.75 Gy with the coverage constraints for the PTV D95 and V95 = 95.0% of 45 Gy. The remaining dosimetric parameters met the recommendations from the clinically acceptable guidelines for the radiotherapy of MPM. Conclusion: Using well-defined TV and VMAT, a consistent TP compared to similar ones from publications was achieved. We obtained a high agreement between the 3D dose reconstructed and the dose calculated.
References
[1]
Wagner, J.C., Sleggs, C.A. and Marchand, P. (1960) Diffuse Pleural Mesothelioma and Asbestos Exposure in the North Western Cape Province. Occupational and Environmental Medicine, 17, 260-271. https://doi.org/10.1136/oem.17.4.260
[2]
McElvenny, D.M., Darnton, A.J., Price, M.J. and Hodgson, J.T. (2005) Mesothelioma Mortality in Great Britain from 1968 to 2001. Occupational Medicine, 55, 79-87.
https://doi.org/10.1093/occmed/kqi034
[3]
Attanoos, R.L., Churg, A., Galateau-Salle, F., Gibbs, A.R. and Roggli, V.L. (2018) Malignant Mesothelioma and Its Non-Asbestos Causes. Archives of Pathology & Laboratory Medicine, 142, 753-760. https://doi.org/10.5858/arpa.2017-0365-RA
[4]
Bonomi, M., De Filippis, C., Lopci, E., Gianoncelli, L., Rizzardi, G., Cerchiaro, E., Ceresoli, G., et al. (2017) Clinical Staging of Malignant Pleural Mesothelioma: Current Perspectives. Lung Cancer: Targets and Therapy, 8, 127-139.
https://doi.org/10.2147/LCTT.S102113
[5]
Geltner, C., Errhalt, P., Baumgartner, B., Ambrosch, G., Machan, B., Klepetko, W., et al. (2016) Management of Malignant Pleural Mesothelioma Part 1: Epidemiology, Diagnosis, and Staging. Wiener Klinische Wochenschrift, 128, 611-617.
https://doi.org/10.1007/s00508-016-1080-z
[6]
Doonan, P.B., Ohnuma, K., Dang, L.H., Morimoto, C. and Dang, N.H. (2017) Current and Emerging Therapy for Malignant Pleural Mesothelioma: Focus on CD26/Dipeptidyl Peptidase IV as a Therapeutic Target. Current Cancer Therapy Reviews, 13, 76-88. https://doi.org/10.2174/1573394713666170907160734
[7]
Runxiao, L., Yankun, C. and Lan, W. (2016) A Pilot Study of Volumetric-Modulated Arc Therapy for Malignant Pleural Mesothelioma. Journal of Applied Clinical Medical Physics, 17, 139-144. https://doi.org/10.1120/jacmp.v17i2.5980
[8]
Franceschini, D., De Rose, F., Cozzi, S., Renna, I., Franzese, C., Di Brina, L., Scorsetti, M., et al. (2019) Volumetric Modulated Arc Therapy after Lung Sparing Surgery for Malignant Pleural Mesothelioma: A Single Institution Experience. Clinical Lung Cancer, 21, 86-93. https://doi.org/10.1016/j.cllc.2019.08.008
[9]
Ozyigit, G., Hurmuz, P., Sari, S.Y., Yazici, G. and Gultekin, M. (2016) Target Volume Delineation Guidelines in Malignant Pleural Mesothelioma. In: Ozyigit, G., Selek, U. and Topkan, E., Eds., Principles and Practice of Radiotherapy Techniques in Thoracic Malignancies, Springer, Cham, Chapter 19, 433-440.
https://doi.org/10.1007/978-3-319-28761-4_19
[10]
Kong, F.-M., Ritter, T., Quint, D.J., Senan, S., Gaspar, L.E., Komaki, R.U., Curran, W.J., et al. (2011) Consideration of Dose Limits for Organs at Risk of Thoracic Radiotherapy: Atlas for Lung, Proximal Bronchial Tree, Esophagus, Spinal Cord, Ribs, and Brachial Plexus. International Journal of Radiation Oncology Biology Physics, 81, 1442-1457. https://doi.org/10.1016/j.ijrobp.2010.07.1977
[11]
Kong, F.-M., Quint, L., Machtay, M. and Bradley, J. (2015) Atlases for Organs at Risk (OARs) in Thoracic Radiation Therapy. RTOG 1106.
http://www.crtog.org/UploadFiles/2016-12/94/R131266931000620.pdf
[12]
Baldini, E.H. (2004) External Beam Radiation Therapy for the Treatment of Pleural Mesothelioma. Thoracic Surgery Clinics, 14, 543-548.
https://doi.org/10.1016/S1547-4127(04)00108-2
[13]
Baldini, E.H. (2015) Adult Chest Surgery, Part 20: Pleural Malignancy, Chapter 118: Radiation Therapy for Mesothelioma. 2nd Edition, McGraw-Hill, New York.
[14]
Krayenbuehl, J., Oertel, S., Davis, J.B. and Ciernik, I.F. (2007) Combined Photon and Electron Three-Dimensional Conformal versus Intensity-Modulated Radiotherapy with Integrated Boost for Adjuvant Treatment of Malignant Pleural Mesothelioma after Pleuropneumonectomy. International Journal of Radiation Oncology Biology Physics, 69, 1593-1599. https://doi.org/10.1016/j.ijrobp.2007.07.2370
[15]
Krayenbuehl, J., Riesterer, O., Graydon, S., et al. (2013) Intensity-Modulated Radiotherapy and Volumetric-Modulated Arc Therapy for Malignant Pleural Mesothelioma after Extrapleural Pleuropneumonectomy. Journal of Applied Clinical Medical Physics, 14, 1-10. https://doi.org/10.1120/jacmp.v14i4.4130
[16]
Fodor, A., Fiorino, C., Dell’Oca, I., Broggi, S., Pasetti, M., Cattaneo, G.M., Muzio, N.G., et al. (2011) PET-Guided Dose Escalation Tomotherapy in Malignant Pleural Mesothelioma. Strahlentherapie Und Onkologie, 187, 736-743.
https://doi.org/10.1007/s00066-011-2234-6
[17]
Lorentini, S., Amichetti, M., Spiazzi, L., Tonoli, S., Magrini, S.M., Fellin, F. and Schwarz, M. (2012) Adjuvant Intensity-Modulated Proton Therapy in Malignant Pleural Mesothelioma. Strahlentherapie Und Onkologie, 188, 216-225.
https://doi.org/10.1007/s00066-011-0038-3
[18]
Davidson, B. (2010) The Diagnostic and Molecular Characteristics of Malignant Mesothelioma and Ovarian/Peritoneal Serous Carcinoma. Cytopathology, 22, 5-21.
https://doi.org/10.1111/j.1365-2303.2010.00829.x
[19]
Teoh, M., Clark, C.H., Wood, K., Whitaker, S. and Nisbet, A. (2011) Volumetric Modulated Arc Therapy: A Review of Current Literature and Clinical Use in Practice. The British Journal of Radiology, 84, 967-996.
https://doi.org/10.1259/bjr/22373346
[20]
Zhang, Q., Yu, X.L., Hu, W.G., Chen, J.Y., Wang, J.Z., Ye, J.S. and Guo, X.M. (2015) Dosimetric Comparison for Volumetric Modulated Arc Therapy and Intensity Modulated Radiotherapy on the Left-Sided Chest Wall and Internal Mammary Nodes Irradiation in Treating Post-Mastectomy Breast Cancer. Radiology and Oncology, 49, 91-98. https://doi.org/10.2478/raon-2014-0033
[21]
Wang, J., Chen, Z., Li, W., et al. (2018) A New Strategy for Volumetric-Modulated Arc Therapy Planning Using AutoPlanning Based Multicriteria Optimization for Nasopharyngeal Carcinoma. Radiation Oncology, 13, Article No. 94.
https://doi.org/10.1186/s13014-018-1042-x
[22]
Salem, N. (2018) Validation of the Octavius 4D Measuring System in Verifying Advanced External Beams Radiotherapy Techniques. Egyptian Journal of Biomedical Engineering and Biophysics, 18, 22-35.
https://doi.org/10.21608/ejbbe.2018.2295.1010
