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the protocol, a 9 field IMRT technique was generated using 6MV energy. The beams chosen
were equidistant to one another about the 360 rotation of the gantry. Beam angles used for
treatment planning included angles 340, 300, 260, 220, 180, 140, 100, 60, and 20
(Figure 2). These beam angles allowed for the best diversification of dose with respect to the OR
around the defined tumor volume.
The PTV optimization technique was set to 100% of the prescription dose since 97% of the PTV
volume was to receive 100% of the prescribed dose. The CTV volume was set slightly higher
than the prescribed dose in order to force the hottest areas of the plan to the CTV. The limits of
the OR were set in accordance with the dose limits outlined in the protocol (Table 1). These
constraints were adjusted as the plan actively optimized. After the initial optimization the
prescription coverage of the PTV was not being met per the protocol. In order to help the
optimization algorithm work more efficiently for the large volume, the PTV was split into
sections. The PTV sections included an upper, lower, right and left volumes. The new PTV
volumes were expanded 3mm outside the RTOG_PTV. Each of these new PTV volumes were
set to an optimization constraint to receive 100% of the prescription dose. After optimizing
several times, the RTOG_PTV received adequate coverage, but the OR were being overdosed.
In order to meet the OR objectives each was worked with one at a time. The small bowel
objective was the first OR worked with. The small bowel objective was finally met when
anterior margin of the new PTV volume were decreased to match the RTOG_PTV. This decrease
in margin allowed the small bowel to be kept under tolerance doses as well as keeping adequate
coverage to the RTOG_PTV. After the small bowel was met next came the rectum, bladder, and
then the femoral head. In order to meet all OR objectives the optimization PTV volumes was
reduced to 1mm beyond the RTOG_PTV. These adjustments allowed for 97% of the
RTOG_PTV to be covered by the prescription dose as well as the OR to meet the protocol
requirements.
Plan Outcome:
Upon final evaluation of the IMRT plan 97% of the PTV volume received
100% of the prescribed dose and 100% of the CTV volume received 98% of the prescribed dose.
All organs at risk objectives were met as outlined in the protocol (Table 2 and Figure 6).
<
<
<
<
30%
60%
35%
15%
volume
volume
volume
volume
40
30
45
15
Gy
Gy
Gy
Gy
Figure 5:
Beam arrangement.
Prescription:
50.4Gy in 28 Tx=
1.8Gy/Day
Organs at risk
Desired objective(s)
Small Bowel
Achieved Objectives
< 30%
Gy
Rectum
< 60% volume 30 Gy < 60%
Gy
Bladder
< 35% volume 45 Gy < 35%
Gy
Femoral Head
< 15% volume 30 Gy < 15%
Gy
Table 2: OR Desired objectives vs Achieved objectives
Figure 6: DVH
volume 38.4
volume 29.6
volume 40.4
volume 28.4