Dosimetric comparison of intensity modulated and volumetric arc radiation therapy for gastric cancer

Li, Zhiping; Zeng, Jing; Wang, Zi; Zhu, Hong; Wei, Yuquan

doi:10.3892/ol.2014.2363

Cited by 12 publications

(13 citation statements)

References 31 publications

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“…In this study, there was 53% reduction in average number of MUs and 76% reduction in measured treatment time with VMAT plans compared with swIMRT plans ( P < 0.001). This is consistent with other published studies that have compared VMAT and IMRT . The shorter treatment time may translate in improved workflow within a radiation department, as typical IMRT slots are 25–30 min long .…”

Section: Discussionsupporting

confidence: 90%

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Volumetric‐modulated arc therapy versus intensity‐modulated radiotherapy for large volume retroperitoneal sarcomas: A comparative analysis of dosimetric and treatment delivery parameters

Taggar

Graham

Kurien

et al. 2017

J Applied Clin Med Phys

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PurposeTo compare dosimetric and treatment delivery parameter differences between volumetric‐modulated arc radiotherapy (VMAT) and intensity‐modulated radiotherapy (IMRT) for large volume retroperitoneal sarcomas (RPS).Materials and MethodsBoth VMAT and IMRT planning were performed on CT datasets of 10 patients with RPS who had been previously treated with preoperative radiotherapy. Plans were optimized to deliver ≥95% dose to the PTV and were evaluated for conformity and homogeneity. Dose to the organs at risk (OARs) (kidney, liver, spinal cord, and bowel space), unspecified tissue, and dose evaluation volumes (DEVs) at 1, 2, and 5 cm from PTV were calculated and compared. Monitor units (MUs) and treatment delivery times were recorded and compared between the two techniques. The deliverability of the large volume RPS VMAT plans was verified by portal dosimetry on a Truebeam™ linac.Results VMAT and IMRT plans were equivalent for PTV coverage and homogeneity (P > 0.05); however, VMAT plans had slightly better conformity index, CI (P < 0.001). Doses to the OARs were not significantly different between VMAT and IMRT plans (P > 0.05). Mean doses to the unspecified tissue as well as at 1, 2, and 5 cm DEVs were lower with VMAT compared with IMRT, P = 0.04 and P < 0.01, respectively. MUs and average beam‐on times were both significantly lower in the VMAT vs IMRT plans, P < 0.001 and P = 0.001, respectively. All VMAT plans passed portal dosimetry delivery verification with an average gamma passing rate of 99.6 ± 0.4%.Conclusions VMAT planning for large volume RPS improved CI, and achieved comparable OAR sparing, as compared with IMRT. As treatment delivery time was lower, the use of VMAT for RPS may translate into improved treatment delivery efficiency.

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Section: Discussionsupporting

confidence: 90%

“…Similar to published literature, D95 in this study was comparable between VMAT and IMRT plans ( P > 0.5); however, CI was statistically improved in favor of VMAT ( P < 0.001). The target volumes in this study, however, were significantly larger than reported by others.…”

Section: Discussionsupporting

confidence: 80%

Volumetric‐modulated arc therapy versus intensity‐modulated radiotherapy for large volume retroperitoneal sarcomas: A comparative analysis of dosimetric and treatment delivery parameters

Taggar

Graham

Kurien

et al. 2017

J Applied Clin Med Phys

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“…In combination with the Monaco treatment planning system (TPS), Erasmus-iCycle is currently used in clinical practice for IMRT and VMAT plan generation for prostate, head and neck, cervical and lung cancer patients [ 19 – 22 ]. Several studies on postoperative gastric cancer patients have dosimetrically evaluated different radiotherapy techniques [ 23 – 26 ]. To our knowledge, no study has been published considering the feasibility and advantages of automated treatment planning for this treatment site.…”

Section: Introductionmentioning

confidence: 99%

Automated VMAT planning for postoperative adjuvant treatment of advanced gastric cancer

et al. 2018

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BackgroundPostoperative/adjuvant radiotherapy of advanced gastric cancer involves a large planning target volume (PTV) with multi-concave shapes which presents a challenge for volumetric modulated arc therapy (VMAT) planning. This study investigates the advantages of automated VMAT planning for this site compared to manual VMAT planning by expert planners.MethodsFor 20 gastric cancer patients in the postoperative/adjuvant setting, dual-arc VMAT plans were generated using fully automated multi-criterial treatment planning (autoVMAT), and compared to manually generated VMAT plans (manVMAT). Both automated and manual plans were created to deliver a median dose of 45 Gy to the PTV using identical planning and segmentation parameters. Plans were evaluated by two expert radiation oncologists for clinical acceptability. AutoVMAT and manVMAT plans were also compared based on dose-volume histogram (DVH) and predicted normal tissue complication probability (NTCP) analysis.ResultsBoth manVMAT and autoVMAT plans were considered clinically acceptable. Target coverage was similar (manVMAT: 96.6 ± 1.6%, autoVMAT: 97.4 ± 1.0%, p = 0.085). With autoVMAT, median kidney dose was reduced on average by > 25%; (for left kidney from 11.3 ± 2.1 Gy to 8.9 ± 3.5 Gy (p = 0.002); for right kidney from 9.2 ± 2.2 Gy to 6.1 ± 1.3 Gy (p < 0.001)). Median dose to the liver was lower as well (18.8 ± 2.3 Gy vs. 17.1 ± 3.6 Gy, p = 0.048). In addition, Dmax of the spinal cord was significantly reduced (38.3 ± 3.7 Gy vs. 31.6 ± 2.6 Gy, p < 0.001). Substantial improvements in dose conformity and integral dose were achieved with autoVMAT plans (4.2% and 9.1%, respectively; p < 0.001). Due to the better OAR sparing in the autoVMAT plans compared to manVMAT plans, the predicted NTCPs for the left and right kidney and the liver-PTV were significantly reduced by 11.3%, 12.8%, 7%, respectively (p ≤ 0.001). Delivery time and total number of monitor units were increased in autoVMAT plans (from 168 ± 19 s to 207 ± 26 s, p = 0.006) and (from 781 ± 168 MU to 1001 ± 134 MU, p = 0.003), respectively.ConclusionsFor postoperative/adjuvant radiotherapy of advanced gastric cancer, involving a complex target shape, automated VMAT planning is feasible and can substantially reduce the dose to the kidneys and the liver, without compromising the target dose delivery.Electronic supplementary materialThe online version of this article (10.1186/s13014-018-1032-z) contains supplementary material, which is available to authorized users.

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“…SAVMAT showed improved left kidney and liver dose sparing compared with 3DCRT, whereas it failed to show an advantage over the IMRT technique. Li et al 47 compared IMRT plans with single-/double-arc VMAT plans and found that double-arc VMAT showed improved tumour coverage and better kidney dose sparing than five-field (5F)-IMRT, and 5F-IMRT and SAVMAT, whereas no advantage was observed regarding liver dose sparing. Hu et al 48 adopted beam angle and multicriteria optimization for IMRT and compared it with the VMAT technique, which showed similar target coverage and OAR sparing.…”

Section: Volumetric Modulated Arc Therapymentioning

confidence: 99%

“…Lesser monitor units and continuous delivery enable VMAT to treat patient with gastric cancer within a shorter time than when using the IMRT technique. 47,48 Proton beam radiation therapy Limited data are available to assess the outcomes of proton beam radiation therapy. A few case reports showed the efficacy of this technique; one study revealed persistent gastric ulcers at the primary lesion without remaining cancer cells after radiation, and another study showed ,5% of residual tumour tissue.…”

Section: Volumetric Modulated Arc Therapymentioning

confidence: 99%

Chemoradiation for gastric cancer: controversies, updates and novel techniques

Fan

Zhang

2015

BJR

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The INT0116 trial established the role of adjuvant chemoradiation (CRT) in the multidisciplinary approach to the management of locally advanced gastric cancer. However, whether adjuvant CRT is indispensable for patients undergoing D2 dissection remains undefined. The adjuvant chemoradiation therapy in stomach cancer (ARTIST) trial, which was designed to compare adjuvant chemotherapy to CRT, failed to demonstrate differences in disease-free and overall survival in the whole study group; however, subgroup analysis indicated that patients with lymph node metastasis may benefit from additional radiation. A follow-up ARTIST II trial is currently under way. The efficacy of adjuvant CRT remains controversial because of variation among studies in the inclusion criteria and treatment delivery methods; however, the identification of patients who would benefit from CRT is critical. Advanced radiotherapy techniques such as intensity-modulated radiotherapy protect normal tissues via motion management and decreased radiation-induced toxicity and contribute to plan optimization. Further studies integrating clinical and molecular factors as well as neoadjuvant CRT are warranted.Gastric cancer is one of the most frequent malignancies. It is the fifth most common malignancy and the third leading cause of cancer-related death in the world.

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Dosimetric comparison of intensity modulated and volumetric arc radiation therapy for gastric cancer

Cited by 12 publications

References 31 publications

Volumetric‐modulated arc therapy versus intensity‐modulated radiotherapy for large volume retroperitoneal sarcomas: A comparative analysis of dosimetric and treatment delivery parameters

Volumetric‐modulated arc therapy versus intensity‐modulated radiotherapy for large volume retroperitoneal sarcomas: A comparative analysis of dosimetric and treatment delivery parameters

Automated VMAT planning for postoperative adjuvant treatment of advanced gastric cancer

Chemoradiation for gastric cancer: controversies, updates and novel techniques

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