Radiotherapy in oncological emergencies: fast-track treatment planning
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RESEARCH
Open Access
Radiotherapy in oncological emergencies: fast-track treatment planning Lukas Nierer* , Franziska Walter, Maximilian Niyazi, Roel Shpani, Guillaume Landry, Sebastian Marschner, Rieke von Bestenbostel, Dominika Dinkel, Gabriela Essenbach, Michael Reiner, Claus Belka and Stefanie Corradini
Abstract Background and purpose: To report on our clinical experience with a newly implemented workflow for radiotherapy (RT) emergency treatments, which allows for a fast treatment application outside the regular workinghours, and its clinical applicability. Methods: Treatment planning of 18 emergency RT patients was carried out using diagnostic computed tomography (CT) without a dedicated RT simulation CT. The cone-beam CT (CBCT) deviations of the first RT treatment were analyzed regarding setup accuracy. Furthermore, feasibility of the “fast-track” workflow was evaluated with respect to dose deviations caused by different Hounsfield unit (HU) to relative electron density (rED) calibrations and RT treatment couch surface shapes via 3D gamma index analysis of exemplary treatment plans. The dosimetric uncertainty introduced by different CT calibrations was quantified. Results: Mean patient setup vs. CBCT isocenter deviations were (0.49 ± 0.44) cm (x), (2.68 ± 1.63) cm (y) and (1.80 ± 1.06) cm (z) for lateral, longitudinal and vertical directions, respectively. Three out of four dose comparisons between the emergency RT plan calculated on the diagnostic CT and the same plan calculated on the treatment planning CT showed clinically acceptable gamma passing rates, when correcting for surface artifacts. The maximum difference of rED was 0.054, while most parts of the CT calibration curves coincided well. Conclusion: In an emergency RT setting, the use of diagnostic CT data for treatment planning might be timesaving and was shown to be suitable for many cases, considering reproducibility of patient setup, accuracy of initial patient setup and accuracy of dose-calculation. Keywords: Emergency radiation treatment, Treatment planning on diagnostic CT, Fast treatment planning, Rapid planning, Emergency RT workflow
Background and purpose Ideally, oncological patients receive RT according to a fixed schedule, which allows for a clinical workflow of approximately 3–7 days from first patient contact to the beginning of treatment. This timeframe is necessary for a thorough assessment of the treatment indication, consideration of available diagnostic imaging data, coordination with other treating physicians, and the routine RT * Correspondence: [email protected] Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
planning workflow. An RT workflow usually includes the acquisition of a planning CT in treatment setup patient positioning, target and organ at risk (OAR) delineation, dose prescription, treatment planning, and dose delivery. Approximately 3% of patients present with medical conditions requiring immediate RT [1]. These oncological emergencies
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