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IMRT1

Rx: 50Gy/25fx

RTOG 1304

4:03 IMRT treatment field delivery time

Beams
DVH
Metrics

Name (ID): W_BRST_005, W_BRST_005 (W_BRST_005)
Plan or PlanSum ID: 10F_SX1

Structure ID Structure Code Patient Structure DVH Objective Evaluator Variation Priority Met Achieved
PTV EVAL   CombinedPTVEval V47.5Gy[%] >=95     Goal 98.38 %
PTV EVAL   CombinedPTVEval V45.0Gy[%] >=90     Goal 99.31 %
PTV EVAL   CombinedPTVEval D50.0%[Gy] <=54 56   Goal 51.481 Gy
PTV EVAL   CombinedPTVEval Max[Gy] <=57.5 60   Variation 59.99 Gy
CONTRALATERAL BREAST   Breast_R D4.99%[Gy] <=3 4.1   Variation 3.896 Gy
IPSILATERAL LUNG   LUNG_L V20.0Gy[%] <=30 35   Goal 24.87 %
IPSILATERAL LUNG   LUNG_L V10.0Gy[%] <=50 60   Goal 42.47 %
IPSILATERAL LUNG   LUNG_L V5.0Gy[%] <=65 70   Variation 67.40 %
CONTRALATERAL LUNG   LUNG_R V5.0Gy[%] <=10 15   Goal 8.52 %
HEART   HEART D5.0%[Gy] <=25 30   Goal 18.011 Gy
HEART   HEART V15.0Gy[%] <=30 35   Goal 7.30 %
HEART   HEART Mean[Gy] <=4 5   Variation 4.945 Gy
Technical Plan Comments

For this challenging anatomy chestwall case, ten (10) fields were selected such that the beam edges defined the shape of the chest wall with most beams concentrated at the medial and lateral sides of the patient.  As is usual with these multifield IMRT chestwall/breast cases, the challenges were as follows:

Achieving the heart mean dose constraint
Dose to the contralateral breast
Target dose heterogeneity

Meeting the ipsilateral lung dose constraints was more straightforward because the Halcyon machine uses a flattening filter free beam that inherently produces less out-of-field dose than a “flattened” beam.  In addition, the two-stage stacked and staggered MLC reduces interleaf leakage.  Finally, as a consequence of the very challenging anatomy, it was difficult to meet the constraints for max allowed dose and the plan was more heterogeneous than is normally desired.  However, all protocol constraints were still met with only minor deviations sited.

Links

Review 3rd party software generated full treatment plan report

PDF

                              

Download full DICOM CT, struct, plan and dose file         

ZIP        

Any reference to a "plan study" are simply what the organizers call each case and may not be a "study" in the FDA sense as they may not have been published in a peer reviewed journal.
Varian does not provide medical advice and these are illustrative examples only.
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