A feasibility study of stereotactic radiosurgery/stereotactic body radiotherapy/stereotactic ablative radiotherapy practice using tomoedge in helical tomotherapy for lung, liver, and spine targets

The primary purpose of the study is to evaluate the implementation of Helical TomoTherapy (HT) for eligible stereotactic radiosurgery/stereotactic body radiotherapy/stereotactic ablative radiotherapy (SRS/SBRT/SABR) cases using TomoEDGE option. The study focuses on reduction of treatment time without compromise in plan quality using TomoEDGE. It is a mode in HT that uses a dynamic opening of the jaws during treatment delivery to reduce the dose penumbra which otherwise is not possible with fixed jaws option. Eligible SRS/SBRT/SABR cases of lung, liver, and spine were used in this study. All planning parameters such as dose prescription to target and critical organs, pitch, and modulation factor were same in all the plans of the same patient with modifications in the field width and jaw mode. First set of plans with 2.5 cm width and second set of plans with 5 cm width were done in dynamic TomoEDGE mode. Third set of plans created with 5 cm width fixed jaw mode and fourth set of plans with 2.5 cm fixed jaw mode for comparison purpose were done. Our observations achieved that a significant milestone with reduction of up to 34.3% in treatment time of liver cases, 35.2% in lung cases, and 28.7% in spine cases was observed using dynamic TomoEDGE mode with 5 cm width, while no significant variation in the planning results compared with plans using 2.5 cm dynamic TomoEDGE option. TomoEDGE is an efficient and useful mode in TomoTherapy to reduce the treatment time with bigger field width in SRS/SBRT/SABR cases without significant changes in the plan quality