A primer on treatment planning aspects for temporally modulated pulsed radiation therapy
Christian Velten, Adam Bayliss, Jiayi Huang, Wolfgang A. Tom\'e

TL;DR
This paper reviews treatment planning techniques for temporally modulated pulsed radiotherapy (TMPRT), focusing on VMAT and 3D-CRT methods, plan evaluation, and delivery accuracy at low dose rates, highlighting their clinical feasibility and technical considerations.
Contribution
It provides a comprehensive overview of planning strategies and technical assessments for TMPRT, including the development of guidelines and evaluation of plan deliverability.
Findings
Single arc VMAT plans are acceptable for TMPRT.
Delivery accuracy at low dose rates is high on modern LINACs.
3D-CRT increases TMPRT accessibility across clinics.
Abstract
Temporally modulated pulsed radiotherapy (TMPRT) delivers conventional fraction doses of radiation using temporally separated pulses of low doses (<30 cGy) yielding fraction-effective dose rates of around 6.7 cGy/min with the goal to exploit tumor radiation hypersensitivity, which was observed in both, preclinical models and in human clinical trials. To facilitate TMPRT, volumetric modulated arc therapy (VMAT) and 3D-CRT planning techniques were developed following the guidelines of the proposed NRG CC-017 trial. Plans were evaluated with respect to homogeneity, conformality, and adherence to dose constraints. Deliverability of plans was assessed using in-phantom measurements for absorbed dose accuracy at low dose rates and using EPID for isodose verification. For VMAT only single arc plans were found to be acceptable due to otherwise unacceptably heterogeneous field doses, while for…
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Taxonomy
TopicsAdvanced Radiotherapy Techniques · Effects of Radiation Exposure · Radiation Therapy and Dosimetry
