SmartArc-based volumetric modulated arc therapy for endometrial cancer: a dosimetric comparison with helical tomotherapy and intensity-modulated radiation therapy

BMC Cancer

Ruijie Yang¹  Junjie Wang¹  Shouping Xu³  Hua Li² 

[1] Department of Radiation Oncology, Peking University Third Hospital, Beijing, China

[2] Department of Obstetrics & Gynecology, Peking University Third Hospital, Beijing, China

[3] Department of Radiation Oncology, General Hospital of the People’s Liberation Army, Beijing, China

关键词: Volumetric modulated arc therapy;    Intensity-modulated radiation therapy;    Helical tomotherapy;    Endometrial cancer;   

Others  :  1079479
DOI  :  10.1186/1471-2407-13-515

 received in 2012-09-20, accepted in 2013-10-28,  发布年份 2013

【 摘 要 】

Background

The purpose of the present study was to investigate the feasibility of using volumetric modulated arc therapy with SmartArc (VMAT-S) to achieve radiation delivery efficiency higher than that of intensity-modulated radiotherapy (IMRT) and helical tomotherapy (HT) when treating endometrial cancer, while maintaining plan quality.

Methods

Nine patients with endometrial cancer were retrospectively studied. Three plans per patient were generated for VMAT-S, IMRT and HT. The dose distributions for the planning target volume (PTV), organs at risk (OARs) and normal tissue were compared. The monitor units (MUs) and treatment delivery time were also evaluated.

Results

The average homogeneity index was 1.06, 1.10 and 1.07 for the VMAT-S, IMRT and HT plans, respectively. The V₄₀ for the rectum, bladder and pelvis bone decreased by 9.0%, 3.0% and 3.0%, respectively, in the VMAT-S plan relative to the IMRT plan. The target coverage and sparing of OARs were comparable between the VMAT-S and HT plans. The average MU was 823, 1105 and 8403 for VMAT-S, IMRT and HT, respectively; the average delivery time was 2.6, 8.6 and 9.5 minutes, respectively.

Conclusions

For endometrial cancer, the VMAT-S plan provided comparable quality with significantly shorter delivery time and fewer MUs than with the IMRT and HT plans. In addition, more homogeneous PTV coverage and superior sparing of OARs in the medium to high dose region were observed in the VMAT-S relative to the IMRT plan.

【 授权许可】

   
2013 Yang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis CC, De Winter KA, Lutgens LC, van den Bergh AC, van de Steen-Banasik E, Beerman H, van Lent M: Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: Multicentre randomized trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet 2000, 355:1404-1411.
• [2]Roberts JA, Zaino R, Keys H: A phase III randomized study of surgery vs surgery plus adjunctive radiation therapy in intermediate risk endometrial adenocarcinoma (GOG no. 99) [abstract]. Gynecol Oncol 1998, 68:135.
• [3]Lujan AE, Mundt AJ, Yamada SD, Rotmensch J, Roeske JC: Intensity-modulated radiotherapy as a means of reducing dose to bone marrow in gynecologic patients receiving whole pelvic radiotherapy. Int J Radiat Oncol Biol Phys 2003, 57:516-521.
• [4]Mundt AJ, Lujan AE, Rotmensch J, Waggoner SE, Yamada SD, Fleming G, Roeske JC: Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys 2002, 52:1330-1337.
• [5]Roeske JC, Lujan A, Rotmensch J, Waggoner SE, Yamada D, Mundt AJ: Intensity-modulated whole pelvis radiation therapy in patients with gynecologic malignancies. Int J Radiat Oncol Biol Phys 2000, 48:1613-1621.
• [6]Lian J, Mackenzie M, Joseph K, Pervez N, Dundas G, Urtasun R, Pearcey R: Assessment of extended-field radiotherapy for stage IIIC endometrial cancer using three-dimensional conformal radiotherapy, intensity-modulated radiotherapy and helical tomotherapy. Int J Radiat Oncol Biol Phys 2008, 70:935-943.
• [7]Hall EJ, Wuu CS: Radiation-induced second cancers: The impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 2003, 56:83-88.
• [8]Palma D, Vollans E, James K, Nakano S, Moiseenko V, Shaffer R, McKenzie M, Morris J, Otto K: Volumetric modulated arc therapy for delivery of prostate radiotherapy: Comparison with intensity-modulated radiotherapy and three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 2008, 72:996-1001.
• [9]Van D, Van C, Van F, Crijns W, Coelmont A, De A, Lamers E, Geussens Y, Nuyts S, Van D, Van T, Vermorken JB, Gregoire V: RapidArc, SmartArc and TomoHD compared with classical step and shoot and sliding window intensity modulated radiotherapy in an oropharyngeal cancer treatment plan comparison. Radiat Oncol 2013, 8:37. BioMed Central Full Text
• [10]Clivio A, Fogliata A, Franzetti-Pellanda A, Nicolini G, Vanetti E, Wyttenbach R, Cozzi L: Volumetric-modulated arc radiotherapy for carcinomas of the anal canal: A treatment planning comparison with fixed field IMRT. Radiother Oncol 2009, 92:118-124.
• [11]Ong CL, Verbakel WF, Cuijpers JP, Slotman BJ, Lagerwaard FJ, Senan S: Stereotactic radiotherapy for peripheral lung tumors: A comparison of volumetric modulated arc therapy with 3 other delivery techniques. Radiother Oncol 2010, 97:437-442.
• [12]Fogliata A, Clivio A, Nicolini G, Vanetti E, Cozzi L: Intensity modulation with photons for benign intracranial tumours: a planning comparison of volumetric single arc, helical arc and fixed gantry techniques. Radiother Oncol 2008, 89:254-262.
• [13]Vanetti E, Clivio A, Nicolini G, Fogliata A, Ghosh-Laskar S, Agarwal JP, Upreti RR, Budrukkar A, Murthy V, Deshpande DD, Shrivastava SK, Dinshaw KA, Cozzi L: Volumetric modulated arc radiotherapy for carcinomas of the oro-pharynx, hypo-pharynx and larynx: A treatment planning comparison with fixed field IMRT. Radiother Oncol 2009, 92:111-117.
• [14]Small W Jr, Mell LK, Anderson P, Creutzberg C, De Los Santos J, Gaffney D, Jhingran A, Portelance L, Schefter T, Lyer R, Varia M, Winter K, Mundt AJ: Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys 2008, 71:428-434.
• [15]Mell LK, Kochanski JD, Roeske JC, Haslam JJ, Mehta N, Yamada SD, Hurteau JA, Collins YC, Lengyel E, Mundt AJ: Dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with concurrent cisplatin and intensity-modulated pelvic radiotherapy. Int J Radiat Oncol Biol Phys 2006, 66:1356-1365.
• [16]Mell LK, Tiryaki H, Ahn KH, Mundt AJ, Roeske JC, Aydogan B: Dosimetric comparison of bone marrow-sparing intensity-modulated radiotherapy versus conventional techniques for treatment of cervical cancer. Int J Radiat Oncol Biol Phys 2008, 71:1504-1510.
• [17]Bzdusek K, Friberger H, Eriksson K, Hårdemark B, Robinson D, Kaus M: Development and evaluation of an efficient approach to volumetric arc therapy planning. Med Phys 2009, 36:2328-2339.
• [18]Cozzi L, Dinshaw KA, Shrivastava SK, Mahantshetty U, Engineer R, Deshpande DD, Jamema SV, Vanetti E, Clivio A, Nicolini G, Fogliata A: A treatment planning study comparing volumetric arc modulation with RapidArc and fixed field IMRT for cervix uteri radiotherapy. Radiother Oncol 2008, 89:180-191.
• [19]Baxter NN, Habermann EB, Tepper JE, Durham SB, Virnig BA: Risk of pelvic fractures in older women following pelvic irradiation. JAMA 2005, 294:2587-2593.
• [20]Pasquier D, Cavillon F, Lacornerie T, Touzeau C, Tresch E, Lartigau E: A dosimetric comparison of tomotherapy and volumetric modulated arc therapy in the treatment of high-risk prostate cancer with pelvic nodal radiation therapy. Int J Radiat Oncol Biol Phys 2013, 85:549-554.
• [21]Davidson MT, Blake SJ, Batchelar DL, Cheung P, Mah K: Assessing the role of volumetric modulated arc therapy (VMAT) relative to IMRT and helical tomotherapy in the management of localized, locally advanced, and post-operative prostate cancer. Int J Radiat Oncol Biol Phys 2011, 80:1550-1558.
• [22]D’Souza WD, Rosen II: Nontumor integral dose variation in conventional radiotherapy treatment planning. Med Phys 2003, 30:2065-2071.