Concurrent Integrated Protection: An Innovative Approach To High-Precision Radiation Therapy

Abstract

Objective: Extra care must be taken when administering stereotactic radiation close to serial organs at risk (OAR). Simultaneous integrated protection (SIP), a novel intensity-modulated radiotherapy (IMRT) prescription concept, is described for quantifiable and comparable dose prescription to targets very close to OAR. Materials and procedures: An intersection volume of a planning risk volume (PRV) with the total planning target volume (PTV) defined the protection volume (PTVSIP). The remainder of the PTV represented the dominant PTV (PTVdom). IMRT was used for the planning process. PTVdom was prescribed a dose in 3, 5, 8, or 12 fractions based on the ICRU. The restrictions on OARs were stated in terms of equieffective doses at 2 Gy (EQD2) and as absolute limits. The dose to an OAR's gross risk volume was to be considerate of the limitations. breach of OAR's constraints.

In summary: For PTV, SIP produces a median dose of ≥100% in order to achieve low toxicity and high local control. This new approach in chest and abdomen stereotactic body radiotherapy is currently being tested in a prospective clinical trial; longer follow-up is necessary to confirm results.