Abstract: To demonstrate the dosimetric potential of volumetric modulated arc therapy (VMAT) for the treatment of patients with medically inoperable stage I/II non-small cell lung cancer (NSCLC) with stereotactic body radiation therapy (SBRT). Fourteen patients treated with 3D-CRT with varying tumor locations, tumor sizes and dose fractionation schemes were chosen for study. The target prescription doses were 48 Gy in 4 fractions, 52. 5 Gy in 5 fractions, 57. 5 Gy in 5 fractions and 60 Gy in 3 fractions for 2, 5, 1 and 6 patients, respectively. VMAT treatment plans with a mix of 2-3 full and/or partial non-coplanar arcs with 5°-25° separations were retrospectively generated using Eclipse version 10. 0. The 3D-CRT and VMAT plans were then evaluated by comparing their target dose, critical structure dose, high dose spillage, and low dose spillage as defined according to RTOG 0813 and RTOG 0236 protocols. The VMAT treatment plans yielded an average 9. 6-33. 7% reduction in dose to critical structures and an average 12. 0-12. 5% increase in conformity compared with the treated 3D-CRT plans. The D2cm improved with VMAT in 11 of 14 cases. The 3 that worsened were still within the acceptance criteria. Of the 14 3D-CRT plans, 7 had a D2cm minor deviation, while only one of the 14 VMAT plans had a D2cm minor deviation. The R50% improved in 13 of the 14 VMAT cases. The 1 case that worsened was still within the acceptance criteria of the RTOG protocol. Of the 14 3D-CRT plans, 7 had an R50% deviation. Only 1 of the 14 VMAT plans had an R50% deviation, but it was still improved compared to the 3D-CRT plan. In this cohort of patients, no dosimetric compromises resulted from planning SBRT treatments with VMAT relative to the 3D-CRT treatment plans actually used in their treatment.

Stereotactic body radiation therapy (SBRT) has emerged as an important innovative treatment for various primary and metastatic cancers. This book provides a comprehensive and up-to-date account of the physical/technological, biological, and clinical aspects of SBRT. It will serve as a detailed resource for this rapidly developing treatment modality. The organ sites covered include lung, liver, spine, pancreas, prostate, adrenal, head and neck, and female reproductive tract. Retrospective studies and prospective clinical trials on SBRT for various organ sites from around the world are examined, and toxicities and normal tissue constraints are discussed. This book features unique insights from world-renowned experts in SBRT from North America, Asia, and Europe. It will be necessary reading for radiation oncologists, radiation oncology residents and fellows, medical physicists, medical physics residents, medical oncologists, surgical oncologists, and cancer scientists.

With the advancement of technology there is an increasing ability for lesions to be treated with higher radiation doses each fraction. This also allows for low fractionated treatments. Because the patient is receiving a higher dose of radiation per fraction and because of the fast dose falloff in these targets there must be extreme accuracy in the delivery. The 6 DOF couch allows for extra rotational corrections and for a more accurate set-up. The movement of the couch needs to be verified to be accurate and because of this, end to end quality assurance tests for the couch have been made. After the set-up is known to be accurate then different treatment techniques can be studied. SBRT of the Spine has a very fast dose falloff near the spinal cord and was typically treated with IMRT. Treatment plans generated using this technique tend to have streaks of low dose radiation, so VMAT is being studied to determine if this treatment technique can reduce the low dose radiation volume as well as improve OAR sparing. For the 6 DOF couch QA, graph paper is placed on the anterior and right lateral sides of the VisionRT OSMS Cube Phantom. Each rotational shift is then applied individually, with a 3 degree shift in the positive and negative directions for pitch and roll. A mark is drawn on the paper to record each shift. A CBCT is then taken of the Cube and known shifts are applied and then an additional CBCT is taken to return the Cube to isocenter. The original IMRT plans for SBRT of the Spine are evaluated and then a plan is made utilizing VMAT. These plans are then compared for low dose radiation, OAR sparing, and conformity. If the original IMRT plan is determined to be an inferior treatment to what is acceptable, then this will be re-planned and compared to the VMAT plan. The VMAT plans had similar OAR sparing, target coverage, and conformity. In all cases the 50% isodose volume was lower for the VMAT plans. All of the tests for the 6 DOF couch are accurate and good to use in our monthly tests. VMAT has shown to be better than IMRT for Spine SBRT and should be used in all cases, when treating the Spine.

Spine Radiosurgery, Second Edition , is a comprehensive text that includes discussions of the latest devices, treatment planning techniques, target definition, and patient selection in this specialty. Written by leading experts in the fields of neurosurgery, radiation oncology, and medical physics, this book is the definitive reference for clinical applications of state-of-the-art radiosurgery of the spine. Key Features: Six new chapters on such topics as histopathological examination of spinal lesions, minimally invasive techniques, and treatment of spinal chordomas More than 100 full-color illustrations demonstrate key concepts Discussion of new treatments for metastatic spine disease and spinal cord compression This book is a must-have resource for clinicians, fellows, and residents in neurosurgery and radiation oncology. Spine surgeons, orthopaedists, medical physicists, and oncologists at all levels will also benefit from the wealth of information provided.

The first clinical book on the hottest topic in radiation oncology, this timely teaching text offers step-by-step guidance in use of IMRT for cancers at each subsite of the head and neck. The book's high-end content gives readers the clinical decision-making expertise and technical proficiency to incorporate this state-of-the-art radiation treatment technique into practice. Unique to this text is the site-specific instruction on target determination and delineation, to ensure adequate treatment of the tumor target while sparing adjacent normal tissue. More than 250 detailed full-color and black-and-white illustrations clarify each step in clinical implementations of head and neck cancer treatment, especially IMRT. The book provides a concise, pertinent overview of the natural course, lymph node spread, diagnostic criteria, and therapeutic options for each head and neck cancer subsite. Numerous tables provide extensive summaries of the IMRT literature. Figures with succinct explanatory text demonstrate the patterns of direct tumor extension and nodal metastasis with which target volumes are determined and delineated. Clinical outcomes for patients treated with IMRT and with conventional techniques are also included.