PLAN COMPARISON:

3D CONFORMAL VS RADIXACT
FOR TREATMENT OF
THORACIC/ABDOMINAL ESOPHAGUS
DANA KOLLER
THE PATIENT

• 87 year old male with locally advanced esophageal adenocarcinoma, stage

T2-3N0M0 (T stage pending results of endoscopic ultrasound)
• Concurrent Carbolplatin/Taxol
• Possible surgical resection to follow therapy
RADIATION TREATMENT PLAN

• CT Sim
• Position: HFS, arms above head, vac-fix
• NPO 4 hours
• 3DCT, IVCT, 4DCT scans were acquired
• Physics Motion Assessment
• Max tumor motion was 6 mm in superior-inferior direction
• Non-gated treatment plan on 3DCT
• 10 phases of 4DCT used to created ITVs to account for respiratory motion
 TARGET VOLUMES

GTVp- Gross disease

ITVp- GTVp plus respiratory

motion

CTV elective- Thoracic and

abodominal esophagus plus
surrounding mediastinal
lymphatics

ITV elective- CTV elective plus

respiratory motion
PTV 54 Gy- ITVp plus 6 mm
margin

PTV 45 Gy- ITV elective plus

6 mm margin
 ORGANS AT RISK

Combined Lung minus GTV

Left Brachial Plexus
Right Brachial Plexus
Heart
Spinal Cord
Cord + 5mm margin
Liver
Colon
Small Bowel
Duodenum
Left Kidney
Right Kidney
 PLAN PRESCRIPTION

Planning objectives are derived from Quantec data for 200 cGy/fraction
 3D CONFORMAL TREATMENT PLAN

USING XIO
FOR ELEKTA INFINITY TREATMENT MACHINE
 INITIAL TREATMENT PLAN

LARGE FIELD TO 45 GY/25 FRACTIONS

PA FIELD LPO FIELD

AP FIELD
18 MV PHOTONS, WEDGE 35 DEGREES 18 MV PHOTONS, GANTRY 125 DEGREES,
18 MV PHOTONS, WEDGE 8 DEGREES
HEEL LEFT, 31.1% WEIGHTED, 1 CM NO WEDGE, 24.2% WEIGHTED, 8 MM
HEEL SUPERIOR, 44.7% WEIGHTED, 1
MARGIN TO BLOCK EDGE MARGIN TO BLOCK EDGE
CM MARGIN TO BLOCK EDGE
4500 CGY/25 FRACTIONS

PLAN NORMALIZED SO
THAT 95% OF PTV 45 GY
RECEIVES 4500 CGY

GLOBAL MAXIMUM=
4878 CGY
(108.4%, LOCATED
OUTSIDE OF TARGET
VOLUME)
 BOOST PLAN

CONEDOWN OF 9 GY/5 FRACTIONS

BOOST PA FIELD BOOST LPO FIELD

BOOST AP FIELD
18 MV PHOTONS, WEDGE 5 DEGREES 18 MV PHOTONS, GANTRY 125 DEGREES,
18 MV PHOTONS, WEDGE 30 DEGREES
HEEL SUPERIOR, 21.2% WEIGHTED, 8 WEDGE 25 DEGREES HEEL POST, 39.9%
HEEL LEFT, 38.9% WEIGHTED, 8MM
MM MARGIN TO BLOCK EDGE WEIGHTED, 8 MM MARGIN TO BLOCK EDGE
MARGIN TO BLOCK EDGE
900 CGY/5 FRACTIONS

PLAN NORMALIZED SO
THAT 95% OF PTV 54 GY
RECEIVES 900 CGY

GLOBAL MAXIMUM=
977.2 CGY
(108.6%, LOCATED
WITHIN TARGET VOLUME)
TOTAL PLAN 5400 CGY/30 FRACTIONS

GLOBAL MAXIMUM=
5756.8 CGY (106.6%)

LOCATED OUTSIDE OF TARGET VOLUMES

PLANNING OBJECTIVES VS PLAN ACHIEVED
 RADIXACT TREATMENT PLAN

USING ACCURAY’S PRECISION PLANNING SYSTEM

RADIXACT OPTIMIZATION STRUCTURES:

LUNG AVOIDANCE
RADIXACT OPTIMIZATION STRUCTURES:

RINGS
RADIXACT OPTIMIZATION STRUCTURES:

BOOST RINGS
INITIAL PLAN
45 GY/25 FX
4500 CGY/25 FRACTIONS

NO PLAN
NORMALIZATION

GLOBAL MAXIMUM=
4998 CGY
(111%, LOCATED WITHIN
TARGET VOLUME)

BEAM ON TIME=
555.5 SECONDS
BOOST PLAN
9 GY/5 FX
900 CGY/5 FRACTIONS

NO PLAN
NORMALIZATION

GLOBAL MAXIMUM=
984 CGY
(109.3%, LOCATED
WITHIN TARGET VOLUME)

BEAM ON TIME=
385.3 SECONDS
TOTAL PLAN 5400 CGY/30 FRACTIONS

GLOBAL MAXIMUM=
5920 CGY (109.6%)

LOCATED WITHIN BOOST TARGET

PLANNING OBJECTIVES VS PLAN ACHIEVED
5800 CGY
5400 CGY
4900 CGY
4500 CGY
4000 CGY
2000 CGY
500 CGY
 COMPARING THE
3D CONFORMAL AND RADIXACT
TREATMENT PLANS
3D CONFORMAL RADIXACT

5800 CGY
5400 CGY
4900 CGY
4500 CGY
4000 CGY
2000 CGY
500 CGY
TOTAL 3D PLAN ACHIEVED: TOTAL RADIXACT PLAN ACHIEVED:
THANK YOU