Pinnacle3 link

Liver and kidney volumes were measured with a segmentation technique, which involves manual tracing of the liver boundaries. A software program interpolates between CT or MRI slices and calculates the areas within the indicated circumference. For liver segmentation we included liver parenchyma and cysts, the gallbladder, vessels surrounded by liver parenchyma and vessels that are part of the liver hilum. Kidney segmentation included kidney tissue, kidney cysts, pyelum and main kidney vessels when fully surrounded by kidney tissue. Excluded were pyelum and kidney vessels when not surrounded by kidney tissue.
For CT scans we used Pinnacle^{3 (link)}® volumetric software version 9.10 (Philips Radiation Oncology Systems; Fitchburg, WI, USA), which has been validated previously for PLD.^{10 (link)–12 (link, link)} MRI scans were measured with ITK-SNAP version 3.4.0 (Penn Image Computing and Science Laboratory, Philadelphia, PA, USA, and Scientific Computing and Imaging Institute, Salt Lake City, UT, USA). We validated ITK-SNAP to measure liver volumes in PLD for this study (Supplemental Appendix) and found a mean difference in liver volume of 1.8% ± 1.1 between ITK-SNAP measurements and Pinnacle^{3 (link)}®. Variability between ITK-SNAP measurements by two independent investigators was −0.4% ± 1.4. These differences were considered acceptable for the purpose of our study.

All plans were designed using the Pinnacle^{3 (link)}
treatment planning system (version 16.2, Philips Healthcare) with
Collapsed Cone Convolution Superposition algorithm and delivered using an Elekta
Versa HD accelerator (Elekta Oncology Systems). All plans used 6-MV FFF X-rays
and were calculated on a dose grid with 4-mm³ voxels using a
collapsed cone convolution algorithm. The prescribed dose was 2 Gy delivered per
fraction for all patients.

All patients received RT with or without sequential or concurrent chemotherapy. Radiation was given via consistent intensity-modulated RT. Treatment planning was performed with a Philips Pinnacle3 (link) radiation treatment planning system (Philips Medical Systems, Amsterdam, Netherlands).
For all patients, gross tumor volume was identified based on the CT images. The gross tumor volume included the tumor and the metastatic lymph nodes. The clinical target volume was based on the gross tumor volume, but also included the primary tumor bed and metastatic lymph nodes before chemotherapy. The distance from the margin of the gross tumor volume to the clinical target volume was 5 mm. The distance from the margin of the clinical target volume to the planning target volume was 5–10 mm. The radiation dose was 50–66 Gy in 20–33 fractions, 1.8–3 Gy per fraction, 1 fraction per day.