The Journey of SRS: An Initial Experience of Starting Sterotactic Radiosurgery Facility at Purbanchal Cancer Hospital—First in Nepal  

作　　者：Birendra Kumar Yadav Karthik Nagamuthu Alok Thakur Kushal Rizal Umesh Kumar Sharma Ujwal Rai Dinesh Thapa Shishir Thapa Kumar Chinnappan Amit Kumar Dubey Suraj Gurung Aman Yadav Utpalkant Kumar Ranjay Kumar Birendra Kumar Yadav;Karthik Nagamuthu;Alok Thakur;Kushal Rizal;Umesh Kumar Sharma;Ujwal Rai;Dinesh Thapa;Shishir Thapa;Kumar Chinnappan;Amit Kumar Dubey;Suraj Gurung;Aman Yadav;Utpalkant Kumar;Ranjay Kumar(Department of Radiation Oncology, Purbanchal Cancer Hospital, Jhapa, Nepal;Department of Radiology, Purbanchal Cancer Hospital, Jhapa, Nepal;Deapartment of Pathology, Purbanchal Cancer Hospital Jhapa, Nepal;Department of Neurosurgery, Purbanchal Cancer Hospital Jhapa, Nepal)

机构地区：[1]Department of Radiation Oncology, Purbanchal Cancer Hospital, Jhapa, Nepal [2]Department of Radiology, Purbanchal Cancer Hospital, Jhapa, Nepal [3]Deapartment of Pathology, Purbanchal Cancer Hospital Jhapa, Nepal [4]Department of Neurosurgery, Purbanchal Cancer Hospital Jhapa, Nepal

出　　处：《International Journal of Medical Physics, Clinical Engineering and Radiation Oncology》2023年第2期37-50,共14页医学物理学、临床工程、放射肿瘤学（英文）

摘　　要：Introduction: Radiotherapy (RT) is a vital cancer treatment modality for both curative and palliative purposes. Nepal is a developing country with a population of around 30 million people. Cancer affects 100 - 120 people out of every 100,000, and the figure is increasing. The number of radiation facility machines in the country is still countable in fingers. Purbanchal Cancer Hospital, Nepal is the first comprehensive cancer facility capable of performing stereotactic radiosurgery (SRS). Our facility has cutting-edge Varian Truebeam Linear Accelerators with millennium MLC, which makes SRS and SRT’S for intracranial lesions such as small benign and malignant tumors much easier. In addition to SRS, we are the pioneers of SBRT for lung using 4DCT, interstitial & intraluminal brachytherapy, RPM Gated & DIBH modalities in Nepal. Methods & Materials: The purpose of this study is to share our experience in establishing an SRS facility in the country, which includes training the RT team on the importance of process accuracy, patient selection, patient assessment, mould preparation, and describing image data acquisition, target, and organ at risk delineation on CT and MRI images, treatment planning process, and quality assurance. Results & Discussion: The plans for all SRS and SRT cases are based on target coverage, OAR sparing, hotspot inside the target, conformity index, heterogeneity index, and dose fall off. To select the final plan, we used strict passing criteria such as a conformity index Paddick (CIPaddick) more than 0.85, a falloff between 100% and 50% of less than 5.5 mm (maximum 6 mm in irregular targets), and a hotspot inside the target between 115 to 140 percent, as per clinical standards. In addition, we determined the CILomax and CIRTOG for each case. Passing criteria for verification plans are set as minimum of 95% for a 2% percentage dose difference (% DD) and a 2-mm distance to an agreement (DTA). We also gathered demographic data from patients treated in the first year, such as diagnosis, lesion size,Introduction: Radiotherapy (RT) is a vital cancer treatment modality for both curative and palliative purposes. Nepal is a developing country with a population of around 30 million people. Cancer affects 100 - 120 people out of every 100,000, and the figure is increasing. The number of radiation facility machines in the country is still countable in fingers. Purbanchal Cancer Hospital, Nepal is the first comprehensive cancer facility capable of performing stereotactic radiosurgery (SRS). Our facility has cutting-edge Varian Truebeam Linear Accelerators with millennium MLC, which makes SRS and SRT’S for intracranial lesions such as small benign and malignant tumors much easier. In addition to SRS, we are the pioneers of SBRT for lung using 4DCT, interstitial & intraluminal brachytherapy, RPM Gated & DIBH modalities in Nepal. Methods & Materials: The purpose of this study is to share our experience in establishing an SRS facility in the country, which includes training the RT team on the importance of process accuracy, patient selection, patient assessment, mould preparation, and describing image data acquisition, target, and organ at risk delineation on CT and MRI images, treatment planning process, and quality assurance. Results & Discussion: The plans for all SRS and SRT cases are based on target coverage, OAR sparing, hotspot inside the target, conformity index, heterogeneity index, and dose fall off. To select the final plan, we used strict passing criteria such as a conformity index Paddick (CIPaddick) more than 0.85, a falloff between 100% and 50% of less than 5.5 mm (maximum 6 mm in irregular targets), and a hotspot inside the target between 115 to 140 percent, as per clinical standards. In addition, we determined the CILomax and CIRTOG for each case. Passing criteria for verification plans are set as minimum of 95% for a 2% percentage dose difference (% DD) and a 2-mm distance to an agreement (DTA). We also gathered demographic data from patients treated in the first year, such as diagnosis, lesion size,

关 键 词：Conformity Index Double Shell Positioning System Electronic Portal Imaging Device Linear Accelerator Millennium MLC Octavius Detector 1500 Setup Field 

分 类 号：R73[医药卫生—肿瘤]