Wang GY, Zhu QZ, Zhu HL, Jiang LJ, Zhao N, Liu ZK, Zhang FQ. Clinical performance evaluation of O-Ring Halcyon Linac: A real-world study. World J Clin Cases 2022; 10(22): 7728-7737 [PMID: 36158510 DOI: 10.12998/wjcc.v10.i22.7728]
Corresponding Author of This Article
Zhi-Kai Liu, MD, Associate Professor, Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, China. liuzk2009@126.com
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Guang-Yu Wang, Qi-Zhen Zhu, He-Ling Zhu, Zhi-Kai Liu, Fu-Quan Zhang, Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Ling-Juan Jiang, Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
Nan Zhao, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Author contributions: Wang GY designed and performed the research and wrote the paper; Liu ZK and Zhang FQ designed the research and supervised the report; Zhu QZ and Zhu HL performed the research; Jiang LJ and Zhao N supervised the report.
Supported bythe National Foundation for Education Sciences Planning, No. BLA 200216; and the National Key Research and Development Plan, Ministry of Science and Technology of the People’s Republic of China, No. 2016YFC0105207.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Peking Union Medical College Hospital (No. S-K1883).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: The authors have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Kai Liu, MD, Associate Professor, Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, China. liuzk2009@126.com
Received: January 6, 2022 Peer-review started: January 6, 2022 First decision: February 8, 2022 Revised: March 7, 2022 Accepted: June 13, 2022 Article in press: June 13, 2022 Published online: August 6, 2022 Processing time: 196 Days and 16.8 Hours
ARTICLE HIGHLIGHTS
Research background
Radiation therapy is commonly used in cancer management. Halcyon, a novel 6MV-flattening-filter-free O-ring linear accelerator (6X-FFF ORL), was designed to deliver treatment with greater speed than a traditional C-arm Linac, demonstrating great advantages.
Research motivation
The development of linear accelerators has played a key role in cancer management. Halcyon, as a new accelerator with many breakthrough innovations, is worthy of further exploration for clinical application. Previous studies have mainly focused on the machine parameters and plan quality of Halcyon, while relevant research on its clinical application has been lacking.
Research objectives
To evaluate the clinical performance of the O-ring Halcyon treatment system in a real-world application setting and share our clinical experience with 6X-FFF ORL radiation therapy for cancer management.
Research methods
Patients who were treated with the Halcyon system throughout the entire radiotherapy process were retrospectively reviewed. We evaluated the Halcyon from three aspects: effects of radiotherapy, irradiation toxicity and quality assurance. Dosimetric verification of Halcyon plans was performed using quality assurance procedures such as portal dosimetry, ArcCHECK and point dose measurements to verify the system delivery accuracy.
Research results
Of the 61 patients in the five groups, no increase in the irradiated target tumour volume was observed when separately evaluating local response. Regarding irradiation toxicity, thirty-eight percent (23/61 patients) had no radiation toxicity after radiotherapy, 56% (34/61 patients) experienced radiation toxicity that resolved after treatment, and 6% (4/61 patients) had irreversible adverse reactions. All of the validated clinical plans were within 3% for point dose measurements, and the average gamma passing rates with a 2% dose difference and 2-mm distance to agreement for IMRT/VMAT/SRT plans were ArcCHECK at 96.4% and portal dosimetry at 96.7%, respectively.
Research conclusions
We showed that the Halcyon platform can generate treatment plans that meet clinically accepted constraints and pass routine patient-specific quality assurance for delivery accuracy verification. For clinics that choose Halcyon as the treatment delivery option, administering VMAT and IMRT is feasible and safe.
Research perspectives
Further follow-up is needed to assess late toxicity and long-term outcomes.
