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Title: A comparative study of standard intensity-modulated radiotherapy and RapidArc planning techniques for ipsilateral and bilateral head and neck irradiation

Abstract

The purpose of this study was to investigate class solutions using RapidArc volumetric-modulated arc therapy (VMAT) planning for ipsilateral and bilateral head and neck (H&N) irradiation, and to compare dosimetric results with intensity-modulated radiotherapy (IMRT) plans. A total of 14 patients who received ipsilateral and 10 patients who received bilateral head and neck irradiation were retrospectively replanned with several volumetric-modulated arc therapy techniques. For ipsilateral neck irradiation, the volumetric-modulated arc therapy techniques included two 360° arcs, two 360° arcs with avoidance sectors around the contralateral parotid, two 260° or 270° arcs, and two 210° arcs. For bilateral neck irradiation, the volumetric-modulated arc therapy techniques included two 360° arcs, two 360° arcs with avoidance sectors around the shoulders, and 3 arcs. All patients had a sliding-window-delivery intensity-modulated radiotherapy plan that was used as the benchmark for dosimetric comparison. For ipsilateral neck irradiation, a volumetric-modulated arc therapy technique using two 360° arcs with avoidance sectors around the contralateral parotid was dosimetrically comparable to intensity-modulated radiotherapy, with improved conformity (conformity index = 1.22 vs 1.36, p < 0.04) and lower contralateral parotid mean dose (5.6 vs 6.8 Gy, p < 0.03). For bilateral neck irradiation, 3-arc volumetric-modulated arc therapy techniques were dosimetrically comparablemore » to intensity-modulated radiotherapy while also avoiding irradiation through the shoulders. All volumetric-modulated arc therapy techniques required fewer monitor units than sliding-window intensity-modulated radiotherapy to deliver treatment, with an average reduction of 35% for ipsilateral plans and 67% for bilateral plans. Thus, for ipsilateral head and neck irradiation a volumetric-modulated arc therapy technique using two 360° arcs with avoidance sectors around the contralateral parotid is recommended. For bilateral neck irradiation, 2- or 3-arc techniques are dosimetrically comparable to intensity-modulated radiotherapy, but more work is needed to determine the optimal approaches by disease site.« less

Authors:
 [1];  [2]; ; ;  [1];  [1];  [2];  [1]
  1. Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA (United States)
  2. (United States)
Publication Date:
OSTI Identifier:
22685178
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Dosimetry; Journal Volume: 42; Journal Issue: 1; Other Information: Copyright (c) 2017 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
61 RADIATION PROTECTION AND DOSIMETRY; 62 RADIOLOGY AND NUCLEAR MEDICINE; AVOIDANCE; BENCHMARKS; COMPARATIVE EVALUATIONS; DELIVERY; DOSES; DOSIMETRY; HEAD; IRRADIATION; MONITORS; NECK; NEOPLASMS; PATIENTS; PLANNING; RADIOTHERAPY; STANDARDS

Citation Formats

Pursley, Jennifer, E-mail: jpursley@mgh.harvard.edu, Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, Damato, Antonio L., Czerminska, Maria A., Margalit, Danielle N., Sher, David J., Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, and Tishler, Roy B. A comparative study of standard intensity-modulated radiotherapy and RapidArc planning techniques for ipsilateral and bilateral head and neck irradiation. United States: N. p., 2017. Web. doi:10.1016/J.MEDDOS.2016.10.004.
Pursley, Jennifer, E-mail: jpursley@mgh.harvard.edu, Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, Damato, Antonio L., Czerminska, Maria A., Margalit, Danielle N., Sher, David J., Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, & Tishler, Roy B. A comparative study of standard intensity-modulated radiotherapy and RapidArc planning techniques for ipsilateral and bilateral head and neck irradiation. United States. doi:10.1016/J.MEDDOS.2016.10.004.
Pursley, Jennifer, E-mail: jpursley@mgh.harvard.edu, Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, Damato, Antonio L., Czerminska, Maria A., Margalit, Danielle N., Sher, David J., Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, and Tishler, Roy B. Sat . "A comparative study of standard intensity-modulated radiotherapy and RapidArc planning techniques for ipsilateral and bilateral head and neck irradiation". United States. doi:10.1016/J.MEDDOS.2016.10.004.
@article{osti_22685178,
title = {A comparative study of standard intensity-modulated radiotherapy and RapidArc planning techniques for ipsilateral and bilateral head and neck irradiation},
author = {Pursley, Jennifer, E-mail: jpursley@mgh.harvard.edu and Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA and Damato, Antonio L. and Czerminska, Maria A. and Margalit, Danielle N. and Sher, David J. and Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX and Tishler, Roy B.},
abstractNote = {The purpose of this study was to investigate class solutions using RapidArc volumetric-modulated arc therapy (VMAT) planning for ipsilateral and bilateral head and neck (H&N) irradiation, and to compare dosimetric results with intensity-modulated radiotherapy (IMRT) plans. A total of 14 patients who received ipsilateral and 10 patients who received bilateral head and neck irradiation were retrospectively replanned with several volumetric-modulated arc therapy techniques. For ipsilateral neck irradiation, the volumetric-modulated arc therapy techniques included two 360° arcs, two 360° arcs with avoidance sectors around the contralateral parotid, two 260° or 270° arcs, and two 210° arcs. For bilateral neck irradiation, the volumetric-modulated arc therapy techniques included two 360° arcs, two 360° arcs with avoidance sectors around the shoulders, and 3 arcs. All patients had a sliding-window-delivery intensity-modulated radiotherapy plan that was used as the benchmark for dosimetric comparison. For ipsilateral neck irradiation, a volumetric-modulated arc therapy technique using two 360° arcs with avoidance sectors around the contralateral parotid was dosimetrically comparable to intensity-modulated radiotherapy, with improved conformity (conformity index = 1.22 vs 1.36, p < 0.04) and lower contralateral parotid mean dose (5.6 vs 6.8 Gy, p < 0.03). For bilateral neck irradiation, 3-arc volumetric-modulated arc therapy techniques were dosimetrically comparable to intensity-modulated radiotherapy while also avoiding irradiation through the shoulders. All volumetric-modulated arc therapy techniques required fewer monitor units than sliding-window intensity-modulated radiotherapy to deliver treatment, with an average reduction of 35% for ipsilateral plans and 67% for bilateral plans. Thus, for ipsilateral head and neck irradiation a volumetric-modulated arc therapy technique using two 360° arcs with avoidance sectors around the contralateral parotid is recommended. For bilateral neck irradiation, 2- or 3-arc techniques are dosimetrically comparable to intensity-modulated radiotherapy, but more work is needed to determine the optimal approaches by disease site.},
doi = {10.1016/J.MEDDOS.2016.10.004},
journal = {Medical Dosimetry},
number = 1,
volume = 42,
place = {United States},
year = {Sat Apr 01 00:00:00 EDT 2017},
month = {Sat Apr 01 00:00:00 EDT 2017}
}
  • Purpose: To compare dosimetric properties and monitor units (MU) of IMRT plans with several VMAT head and neck (H and N) plans. Methods: Seventeen unilateral H and N (UHN) and five bilateral H and N (BHN) patients initially treated with IMRT were replanned with VMAT. Several arc arrangements were studied for each patient: 1)for UHN, two 360° arcs, two 260° arcs, two 210° arcs, two 360° arcs with contralateral avoidance sectors, and 2)for BHN, two 360° arcs, two 360° arcs with bilateral avoidance sectors, two 360° arcs with bilateral avoidance sectors and a third arc limited to the upper neck.more » Optimization constraints were adjusted for each patient and plan. All plans were normalized to achieve the same highest-dose PTV coverage. Percent differences (IMRT-VMAT)/VMAT in MU, dose homogeneity (HI=maximum point dose/prescription dose), and organ-at-risk (OAR) metrics are reported and statistical significance evaluated (p<0.05; paired Student t-test). Results: Average reduction in MU with VMAT was 28% for UHN (p<0.0001) and 63% for BHN (p<0.0001). Average HI for UHN IMRT and 360° arc VMAT plans was 1.08 and for plans with arcs <360° average HI=1.10. Average HI for BHN IMRT was 1.07, for three-arc VMAT 1.08, and for two-arc VMAT 1.11. For UHN, two 210° arcs achieved lower contralateral parotid max (−2.6 Gy, p<0.02) and mean (−1.2 Gy, p=0.06) dose. For BHN two-arc plans, contralateral parotid mean dose increased (3.3 Gy, p<0.04) and larynx max dose increased (2.9 Gy, p<0.02) with no change in larynx mean dose. Conclusion: For UHN, 360degree arc VMAT consistently produced plans dosimetrically comparable to IMRT with the benefit of lower MU. VMAT with arcs <360degrees produced plans inferior to IMRT in dose homogeneity and without significantly improved OAR sparing. For BHN, three-arc plans were dosimetrically comparable to IMRT with lower MU, while two-arc plans were inferior to IMRT in HI and OAR dose. Research supported in part by a Kaye Family Award.« less
  • To evaluate a nonstandard RapidArc (RA) modality as alternative to high-dose-rate brachytherapy (HDR-BRT) or IMRT treatments of the vaginal vault in patients with gynecological cancer (GC). Nonstandard (with vaginal applicator) and standard (without vaginal applicator) RapidArc plans for 27 women with GC were developed to compare with HDR-BRT and IMRT. Dosimetric and radiobiological comparison were performed by means of dose-volume histogram and equivalent uniform dose (EUD) for planning target volume (PTV) and organs at risk (OARs). In addition, the integral dose and the overall treatment times were evaluated. RA, as well as IMRT, results in a high uniform dose onmore » PTV compared with HDR-BRT. However, the average of EUD for HDR-BRT was significantly higher than those with RA and IMRT. With respect to the OARs, standard RA was equivalent of IMRT but inferior to HDR-BRT. Furthermore, nonstandard RA was comparable with IMRT for bladder and sigmoid and better than HDR-BRT for the rectum because of a significant reduction of d{sub 2cc}, d{sub 1cc}, and d{sub max} (p < 0.01). Integral doses were always higher than HDR-BRT, although the values were very low. Delivery times were about the same and more than double for HDR-BRT compared with IMRT and RA, respectively. In conclusion, the boost of dose on vaginal vault in patients affected by GC delivered by a nonstandard RA technique was a reasonable alternative to the conventional HDR-BRT because of a reduction of delivery time and rectal dose at substantial comparable doses for the bladder and sigmoid. However HDR-BRT provides better performance in terms of PTV coverage as evidenced by a greater EUD.« less
  • Radiation therapy for head and neck malignancies can have side effects that impede quality of life. Theoretically, proton therapy can reduce treatment-related morbidity by minimizing the dose to critical normal tissues. We evaluated the feasibility of spot-scanning proton therapy for head and neck malignancies and compared dosimetry between those plans and intensity-modulated radiation therapy (IMRT) plans. Plans from 5 patients who had undergone IMRT for primary tumors of the head and neck were used for planning proton therapy. Both sets of plans were prepared using computed tomography (CT) scans with the goals of achieving 100% of the prescribed dose tomore » the clinical target volume (CTV) and 95% to the planning TV (PTV) while maximizing conformity to the PTV. Dose-volume histograms were generated and compared, as were conformity indexes (CIs) to the PTVs and mean doses to the organs at risk (OARs). Both modalities in all cases achieved 100% of the dose to the CTV and 95% to the PTV. Mean PTV CIs were comparable (0.371 IMRT, 0.374 protons, p = 0.953). Mean doses were significantly lower in the proton plans to the contralateral submandibular (638.7 cGy IMRT, 4.3 cGy protons, p = 0.002) and parotid (533.3 cGy IMRT, 48.5 cGy protons, p = 0.003) glands; oral cavity (1760.4 cGy IMRT, 458.9 cGy protons, p = 0.003); spinal cord (2112.4 cGy IMRT, 249.2 cGy protons, p = 0.002); and brainstem (1553.52 cGy IMRT, 166.2 cGy protons, p = 0.005). Proton plans also produced lower maximum doses to the spinal cord (3692.1 cGy IMRT, 2014.8 cGy protons, p = 0.034) and brainstem (3412.1 cGy IMRT, 1387.6 cGy protons, p = 0.005). Normal tissue V{sub 10}, V{sub 30}, and V{sub 50} values were also significantly lower in the proton plans. We conclude that spot-scanning proton therapy can significantly reduce the integral dose to head and neck critical structures. Prospective studies are underway to determine if this reduced dose translates to improved quality of life.« less
  • Purpose: Volumetric intensity-modulated arc therapy (RA) allows for rapid delivery of highly conformal dose distributions. In this study, planning and dosimetry of RA were compared with conventional intensity-modulated radiation therapy (IMRT) plans of head-and-neck cancer patients. Materials and Methods: Computed tomography scans of 12 patients who had completed IMRT for advanced tumors of the naso-, oro- and hypopharynx were replanned using RA using either one or two arcs. Calculated doses to planning target volume (PTV) and organs at risk (OAR) were compared between IMRT and RA plans. Dose distributions for single arc (n = 8) and double arc (n =more » 4) plans were verified using film dosimetry in three to five coronal planes using a quality assurance phantom. Results: RA plans allowed for a mean reduction in number of monitor units (MU) by nearly 60%, relative to seven field sliding window IMRT plans. RA plans achieved similar sparing of all OAR as IMRT. Double arc RA provided the best dose homogeneity to PTV with a lower standard deviation of PTV dose (1.4 Gy), vs. single arc plans (2.0 Gy) and IMRT (1.7 Gy). Film measurements showed good correspondence with calculated doses; the mean gamma value was 0.30 (double arc) and area of the film with a gamma exceeding 1 was 0.82%. Conclusions: RA is a fast, safe, and accurate technique that uses lower MUs than conventional IMRT. Double arc plans provided at least similar sparing of OAR and better PTV dose homogeneity than single arc or IMRT.« less
  • RapidArc is a novel technique using arc radiotherapy aiming to achieve intensity-modulated radiotherapy (IMRT)-quality radiotherapy plans with shorter treatment time. This study compared the dosimetric quality and treatment efficiency of single-arc (SA) vs. double-arc (DA) and IMRT in the treatment of prostate cancer. Fourteen patients were included in the analysis. The planning target volume (PTV), which contained the prostate gland and proximal seminal vesicles, received 76 Gy in 38 fractions. Seven-field IMRT, SA, and DA plans were generated for each patient. Dosimetric quality in terms of the minimum PTV dose, PTV hotspot, inhomogeneity, and conformity index; and sparing of rectum,more » bladder, and femoral heads as measured by V70, V-40, and V20 (% of volume receiving >70 Gy, 40 Gy, and 20 Gy, respectively), treatment efficiency as assessed by monitor units (MU) and treatment time were compared. All plan objectives were met satisfactorily by all techniques. DA achieved the best dosimetric quality with the highest minimum PTV dose, lowest hotspot, and the best homogeneity and conformity. It was also more efficient than IMRT. SA achieved the highest treatment efficiency with the lowest MU and shortest treatment time. The mean treatment time for a 2-Gy fraction was 4.80 min, 2.78 min, and 1.30 min for IMRT, DA, and SA, respectively. However, SA also resulted in the highest rectal dose. DA could improve target volume coverage and reduce treatment time and MU while maintaining equivalent normal tissue sparing when compared with IMRT. SA achieved the greatest treatment efficiency but with the highest rectal dose, which was nonetheless within tolerable limits. For busy units with high patient throughput, SA could be an acceptable option.« less