A treatment planning study comparing Elekta VMAT and fixed field IMRT using the varian treatment planning system eclipse

Peters, Samuel; Schiefer, Hans; Plaßwilm, Ludwig

doi:10.1186/1748-717x-9-153

Cited by 36 publications

(24 citation statements)

References 32 publications

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“…Furthermore, the dosimetric advantages of SIB over SB have been previously demonstrated (14, 15,22). Compared to the most widely used sequential electron boost, (23,24). In the present study, our dose distribution analysis showed more conformity and less dose spilling to the ipsilateral breast tissue outside the boost volume with the SIB technique compared to SB technique.…”

Section: Discussionsupporting

confidence: 70%

Dosimetric Comparison of Sequential Versus Simultaneous-integrated Boost in Early-stage Breast Cancer Patients Treated With Breast-conserving Surgery

Onal

Efe

Güler

et al. 2019

In Vivo

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Background/Aim: To compare simultaneousintegrated boost (SIB) versus sequential-boost (SB) delivered in the context of whole-breast irradiation (WBI) via volumetricmodulated arc therapy (VMAT) and helical-tomotherapy (HT). Materials and Methods: Planning target-volume (PTV) dosimetric parameters and organs at risk (OAR) were analyzed for SB plan (50 Gy plus 16 Gy boost) and SIB plan (50.4 Gy WBI and 64.4 Gy tumor bed boost) in VMAT and HT techniques. Results: Conformity and homogeneity for targetvolume doses were better in HT plans compared to VMAT plans. There were no significant differences in ipsilateral lung doses between VMAT and HT plans for SB/SIB techniques, except for a significantly higher lung V5 value with VMAT-SB, and lung V13 value with HT-SIB technique. HT provided a statistically significant decrease in contralateral lung mean V5. Conclusion: The SIB technique showed better target-volume dose distribution in both HT and VMAT plans, and better sparing heart in HT compared to the SB technique. Breast cancer (BC) is the most common cancer and is a major cause of cancer-related death in women (1). Currently, adjuvant radiotherapy (RT), especially whole-breast irradiation (WBI) after breast-conserving surgery (BCS), is accepted as standard-of-care for early BC patients as this multimodal treatment increases local control and improves overall survival in early BC (2, 3). Additional tumor-bed boost after WBI has also been shown to reduce local recurrence (4); however, a long-term follow-up study found that inhomogeneous radiation in tumor-bed boosts, and use of photon beam boosts led to poorer cosmetic outcomes in patients (5). Therefore, in the past few decades, a lot of attention has focused on the development of new techniques to achieve a homogeneous dose distribution, better local control, and improve cosmetic outcomes for WBI after BCS. Breast RT techniques range from conventional tangential field RT, field-in-field conformal RT (CRT), intensity modulated RT (IMRT), volumetric arc therapy (VMAT) to helical tomotherapy (6-11). For tumor-bed boost, relatively simple electron or hybrid techniques (i.e., a combination of different techniques for WBI and boosts), have been used. Recent dosimetric studies have demonstrated that multi-field 3D-CRT, IMRT, or VMAT are superior to electron therapy with respect to the target-volume coverage and sparing normal tissues (12-15). Moreover, simultaneous-integrated boost (SIB), which is a technique wherein a boost is delivered to the tumor bed concurrently with WBI, has been reported to be technically and dosimetrically feasible (11-13, 15-17). The rationale underlying the SIB technique is to escalate radiation doses in the area at highest risk without prolonging treatment duration. This dose escalation provides improved patient comfort while shortening the duration of RT, and also exploits the higher sensitivity of breast tumor cells to larger single doses. However, more advanced techniques are required to increase the uniformity of the radiation dose to improve p...

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Section: Discussionsupporting

confidence: 70%

Dosimetric Comparison of Sequential Versus Simultaneous-integrated Boost in Early-stage Breast Cancer Patients Treated With Breast-conserving Surgery

Onal

Efe

Güler

et al. 2019

In Vivo

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“…While details differ between these studies – due on the one hand to variations in the considered prostate PTV contours, and on the other hand to different planning approaches – it was generally found that VMAT treatment offers at least as good quality plans as IMRT treatment, sometimes even with better sparing of organs at risk. Depending on whether one or two arcs were chosen for VMAT treatment and whether constant or variable dose rate irradiation was allowed, plan quality measures and OAR DVH values sometimes favoured IMRT, sometimes VMAT treatment [ 16 - 24 ]; however, all studies observed a marked reduction in treatment time by VMAT treatment, and generally a drastic reduction in monitor units.…”

Section: Discussionmentioning

confidence: 99%

mARC vs. IMRT radiotherapy of the prostate with flat and flattening-filter-free beam energies

et al. 2014

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BackgroundThere as yet exists no systematic planning study investigating the novel mARC rotational radiotherapy technique, which is conceptually different from VMAT. We therefore present a planning study for prostate cancer, comparing mARC with IMRT treatment at the same linear accelerator equipped with flat and flattening-filter-free (FFF) photon energies.MethodsWe retrospectively re-contoured and re-planned treatment plans for 10 consecutive prostate cancer patients. Plans were created for a Siemens Artiste linear accelerator with flat 6 MV and FFF 7 MV photons, using the Prowess Panther treatment planning system. mARC and IMRT plans were compared with each other considering indices for plan quality and dose to organs at risk. All plans were exported to the machine and irradiated while measuring scattered dose by thermoluminescent dosimeters placed on an anthropomorphic phantom. Treatment times were also measured and compared.ResultsAll plans were found acceptable for treatment. There was no marked preference for either technique or energy from the point of view of target coverage and dose to organs at risk. Scattered dose was significantly decreased by the use of FFF energies. While mARC and IMRT plans were of very similar overall quality, treatment time could be markedly decreased both by the use of mARC and FFF energy.ConclusionsHighly conformal treatment plans could be created both by the use of flat 6 MV and FFF 7 MV energy, using IMRT or mARC. For all practical purposes, the FFF 7 MV energy and mARC plans are acceptable for treatment, a combination of both allowing a drastic reduction in treatment time from over 5 minutes to about half this value.

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“…IMRT, which has the advantage of integrating a multileaf collimator, rotational fan, cone beam delivery system, and robotic arm linear accelerator, delivers a high radiation dose to the target while minimizing the exposure of the organs at risk. Moreover, the arc-based approach for VMAT delivery is designed to further improve dose distribution through dynamic modulation of the gantry rotation speed, dose rate, and multileaf collimator shaping, thereby generating patterns of intensity modulation that deliver optimal treatment doses to the patient [12,13]. Modern radiotherapy techniques are associated with better survival rates than conventional radiation delivery for numerous cancer treatments [14,15].…”

Section: Introductionmentioning

confidence: 99%

Impact of adjuvant radiotherapy on the survival of women with optimally resected stage III endometrial cancer in the era of modern radiotherapy: a retrospective study

Chen

Huang

et al. 2020

Radiat Oncol

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Background: The optimal adjuvant treatment for stage III endometrial cancer in the era of modern radiotherapy remains undefined. We investigated the benefit of adjuvant radiotherapy for women who underwent optimal resection for stage III endometrial cancer in the era of modern radiotherapy. Methods: We retrospectively reviewed patients with endometrial cancer who were treated between 2010 and 2018. Adjuvant treatment included radiotherapy by modern radiotherapy techniques (intensity-modulated or volumetric modulated arc radiotherapy), chemotherapy, or both. Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method and analyzed via multivariate Cox proportional hazards models. Results: One hundred sixty-one patients were initially included (52, 9, and 100 with stages IIIA, IIIB, and IIIC cancer, respectively); 154 patients (96%) received adjuvant therapy. Such adjuvant treatment was associated with improved RFS (p = 0.014) and OS (p = 0.044) over surgery alone. Adjuvant radiotherapy by modern radiotherapy techniques led to low incidence of acute (25%) and chronic (7%) grade ≥ 2 gastrointestinal toxicity. On univariate analysis, non-endometrioid histology and grade 3 status were associated with higher risks of tumor recurrence and death, whereas adjuvant radiotherapy alone or in combination chemotherapy reduced their risks. On multivariate analysis, non-endometrioid histology was associated with increased recurrence (hazard ratio [HR], 2.95; p = 0.009), whereas adjuvant radiotherapy alone or with chemotherapy was associated with lower recurrence (HR, 0.62; p = 0.042). Patients > 60 years of age (p = 0.038) as well as those with endometrioid histology (p = 0.045), lymphovascular space invasion (p = 0.031), and ≥ 2 positive lymph nodes (p = 0.044) benefited most from adjuvant radiotherapy. Conclusions: Modern adjuvant radiotherapy (intensity-modulated or volumetric modulated arc radiotherapy) alone or with chemotherapy should be considered for women with optimally resected stage III endometrial cancer.

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A treatment planning study comparing Elekta VMAT and fixed field IMRT using the varian treatment planning system eclipse

Cited by 36 publications

References 32 publications

Dosimetric Comparison of Sequential Versus Simultaneous-integrated Boost in Early-stage Breast Cancer Patients Treated With Breast-conserving Surgery

Dosimetric Comparison of Sequential Versus Simultaneous-integrated Boost in Early-stage Breast Cancer Patients Treated With Breast-conserving Surgery

mARC vs. IMRT radiotherapy of the prostate with flat and flattening-filter-free beam energies

Impact of adjuvant radiotherapy on the survival of women with optimally resected stage III endometrial cancer in the era of modern radiotherapy: a retrospective study

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