Efficacy of flattening-filter-free beam in stereotactic body radiation therapy planning and treatment: a systematic review with meta-analysis

Dang, Thu M., Peters, Mitchell J., Hickey, Brigid and Semciw, Adam (2017) Efficacy of flattening-filter-free beam in stereotactic body radiation therapy planning and treatment: a systematic review with meta-analysis. Journal of Medical Imaging and Radiation Oncology, 61 3: 379-387. doi:10.1111/1754-9485.12583


Author Dang, Thu M.
Peters, Mitchell J.
Hickey, Brigid
Semciw, Adam
Title Efficacy of flattening-filter-free beam in stereotactic body radiation therapy planning and treatment: a systematic review with meta-analysis
Journal name Journal of Medical Imaging and Radiation Oncology   Check publisher's open access policy
ISSN 1754-9485
1754-9477
Publication date 2017-06-01
Sub-type Article (original research)
DOI 10.1111/1754-9485.12583
Open Access Status Not yet assessed
Volume 61
Issue 3
Start page 379
End page 387
Total pages 9
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Abstract A linear accelerator with the flattening-filter removed generates a non-uniform dose profile beam. We aimed to analyse and compare plan quality and treatment time between flattened beam (FB) and flattening-filter-free (FFF) beam to assess the efficacy of FFF beam for stereotactic body radiation therapy (SBRT). The search strategy was based around 3 concepts; radiation therapy, flattening-filter-free and treatment delivery. The years searched were restricted from 2010 to date of review (October 2015). All plan quality comparisons were between FFF and FB plans from the same data sets. We identified 210 potential studies based on the three searched concepts. All articles were screened by two authors for title and abstract and by three authors for full text. Ten studies met the eligibility criteria. Plan quality was evaluated using conformity index (CI), heterogeneity index (HI) and gradient index (GI). Dose to organs-at-risk (OAR) and healthy tissues were compared. Differences between beam-on-time (BOT) and treatment time (T × T) were also analysed. Normalized percentage ratios of CI and HI demonstrated no clinical differences among the studied articles. GI displayed small variations between the articles favouring FFF beam. The BOT with FFF is substantially reduced, and appears to impact the frequency of intra-fraction imaging which, in turn, affects total treatment time. Based on planning tumour volume (PTV) coverage, dose to OAR and healthy tissue sparing, FFF beam is clinically effective for the treatment of cancer patients using SBRT. We recommend the use of FFF beam for SBRT based on these factors and the reported overall treatment time reduction.
Keyword Flattening-filter-free
Radiation therapy
Radiation treatment delivery
Radiation treatment planning
Stereotactic body radiation therapy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Health and Rehabilitation Sciences Publications
 
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