Dosimetric errors during treatment of centrally located lung tumors with stereotactic body radiation therapy: Monte Carlo evaluation of tissue inhomogeneity corrections.

Early experience with stereotactic body radiation therapy (SBRT) of centrally located lung tumors indicated increased rate of high-grade toxicity in the lungs. These clinical results were based on treatment plans that were computed using pencil beam-like algorithms and without tissue inhomogeneity corrections. In this study, we evaluated the dosimetric errors in plans with and without inhomogeneity corrections and with planning target volumes (PTVs) that were within the zone of the proximal bronchial tree (BT). For 10 patients, the PTV, lungs, and sections of the BT either inside or within 2cm of the PTV were delineated. Two treatment plans were generated for each patient using the following dose-calculation methods: (1) pencil beam (PB) algorithm without inhomogeneity correction (IC) (PB - IC) and (2) PB with inhomogeneity correction (PB + IC). Both plans had identical beam geometry but different beam segment shapes and monitor units (MU) to achieve similar conformal dose coverage of PTV. To obtain the baseline dose distributions, each plan was recalculated using a Monte Carlo (MC) algorithm by keeping MUs the same in the respective plans. The median maximum dose to the proximal BT and PTV dose coverage in the PB + IC plans were overestimated by 8% and 11%, respectively. However, the median maximum dose to the proximal BT and PTV dose coverage in PB - IC plans were underestimated by 15% and 9%. Similar trends were observed in low-dose regions of the lung within the irradiated volume. Our study indicates that dosimetric bias introduced by unit tissue density plans cannot be characterized as underestimation or overestimation of dose without taking the tumor location into account. This issue should be considered when analyzing clinical toxicity data from early lung SBRT trials that utilized unit tissue density for dose calculations.

Dose prediction accuracy of anisotropic analytical algorithm and pencil beam convolution algorithm beyond high density heterogeneity interface.

PURPOSE: It is well known that photon beam radiation therapy requires dose calculation algorithms. The objective of this study was to measure and assess the ability of pencil beam convolution (PBC) and anisotropic analytical algorithm (AAA) to predict doses beyond high density heterogeneity. MATERIALS AND METHODS: An inhomogeneous phantom of five layers was created in Eclipse planning system (version 8.6.15). Each layer of phantom was assigned in terms of water (first or top), air (second), water (third), bone (fourth), and water (fifth or bottom) medium. Depth doses in water (bottom medium) were calculated for 100 monitor units (MUs) with 6 Megavoltage (MV) photon beam for different field sizes using AAA and PBC with heterogeneity correction. Combinations of solid water, Poly Vinyl Chloride (PVC), and Styrofoam were then manufactured to mimic phantoms and doses for 100 MUs were acquired with cylindrical ionization chamber at selected depths beyond high density heterogeneity interface. The measured and calculated depth doses were then compared. RESULTS: AAA's values had better agreement with measurements at all measured depths. Dose overestimation by AAA (up to 5.3%) and by PBC (up to 6.7%) was found to be higher in proximity to the high-density heterogeneity interface, and the dose discrepancies were more pronounced for larger field sizes. The errors in dose estimation by AAA and PBC may be due to improper beam modeling of primary beam attenuation or lateral scatter contributions or combination of both in heterogeneous media that include low and high density materials. CONCLUSIONS: AAA is more accurate than PBC for dose calculations in treating deep-seated tumor beyond high-density heterogeneity interface.