Dosimetric comparison of volumetric modulated arc therapy and intensity-modulated radiation therapy for pancreatic malignancies

Ali, Arif; Dhabaan, Anees; Jarrio, Christie S.; Siddiqi, A; Landry, Jerome C.

doi:10.1016/j.meddos.2011.10.001

Cited by 26 publications

(16 citation statements)

References 37 publications

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“…13–16 These studies were performed for conventionally fractionated radiation regimens and were designed to address the efficacy of VMAT in comparison with standard 5-field IMRT. Eppinga and colleagues reported improved CI with VMAT treatment, reduced dose to OARs, and decreased treatment delivery times.…”

Section: Discussionmentioning

confidence: 99%

“…Although this technique has been studied in many anatomical sites, 4 relatively recent studies have specifically addressed utilization of VMAT in the treatment of pancreatic cancer. 13–16 Eppinga et al . published a series of 10 cases assessing the delivery of VMAT as an alternative to standard 5-field IMRT in advanced pancreatic cancer.…”

Section: Introductionmentioning

confidence: 99%

“…compared VMAT with IMRT and found improved monitor units (MU) and bilateral kidney dose with VMAT. 16 …”

Section: Introductionmentioning

confidence: 99%

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Stereotactic body radiation therapy planning with duodenal sparing using volumetric-modulated arc therapy vs intensity-modulated radiation therapy in locally advanced pancreatic cancer: A dosimetric analysis

Kumar¹,

Wild²,

Ziegler³

et al. 2013

Medical Dosimetry

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Stereotactic body radiation therapy (SBRT) achieves excellent local control for locally advanced pancreatic cancer (LAPC), but may increase late duodenal toxicity. Volumetric-modulated arc therapy (VMAT) delivers intensity-modulated radiation therapy (IMRT) with a rotating gantry rather than multiple fixed beams. This study dosimetrically evaluates the feasibility of implementing duodenal constraints for SBRT using VMAT vs IMRT. Non–duodenal sparing (NS) and duodenal-sparing (DS) VMAT and IMRT plans delivering 25 Gy in 1 fraction were generated for 15 patients with LAPC. DS plans were constrained to duodenal Dmax of <30 Gy at any point. VMAT used 1 360° coplanar arc with 4° spacing between control points, whereas IMRT used 9 coplanar beams with fixed gantry positions at 40° angles. Dosimetric parameters for target volumes and organs at risk were compared for DS planning vs NS planning and VMAT vs IMRT using paired-sample Wilcoxon signed rank tests. Both DS VMAT and DS IMRT achieved significantly reduced duodenal Dmean, Dmax, D1cc, D4%, and V20 Gy compared with NS plans (all p ≤ 0.002). DS constraints compromised target coverage for IMRT as demonstrated by reduced V95% (p = 0.01) and Dmean (p = 0.02), but not for VMAT. DS constraints resulted in increased dose to right kidney, spinal cord, stomach, and liver for VMAT. Direct comparison of DS VMAT and DS IMRT revealed that VMAT was superior in sparing the left kidney (p < 0.001) and the spinal cord (p < 0.001), whereas IMRT was superior in sparing the stomach (p = 0.05) and the liver (p = 0.003). DS VMAT required 21% fewer monitor units (p < 0.001) and delivered treatment 2.4 minutes faster (p < 0.001) than DS IMRT. Implementing DS constraints during SBRT planning for LAPC can significantly reduce duodenal point or volumetric dose parameters for both VMAT and IMRT. The primary consequence of implementing DS constraints for VMAT is increased dose to other organs at risk, whereas for IMRT it is compromised target coverage. These findings suggest clinical situations where each technique may be most useful if DS constraints are to be employed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Stereotactic body radiation therapy planning with duodenal sparing using volumetric-modulated arc therapy vs intensity-modulated radiation therapy in locally advanced pancreatic cancer: A dosimetric analysis

Kumar¹,

Wild²,

Ziegler³

et al. 2013

Medical Dosimetry

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“…8 In addition to better conformity, journal homepage: www.meddos.org VMAT was proven to have lesser monitor units and shorter treatment time. 9,10 Organs, e.g., liver, small bowel, spinal cord, and bilateral kidneys, were also shown to have similar or better dosimetric results with VMAT over IMRT, as well as 3D-CRT. 11 Because VMAT delivers radiation beams continuously in a complete gantry rotation, patients are exposed to low dose spillage in a large region outside of the intended target.…”

Section: Introductionmentioning

confidence: 92%

Ipsilateral kidney sparing in treatment of pancreatic malignancies using volumetric-modulated arc therapy avoidance sectors

Chan

Podgorsak

2015

Medical Dosimetry

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“…Similar to our study design, Ali et al, analyzed 10 patients' dosimetric data and concluded that using double arc VMAT for curative or adjuvant radiotherapy for pancreas cancer patients, provides lower mean and V20-V15 doses of both kidney compared to IMRT, but other organ doses of both plans were found to be similar. [22] This gain for bilateral kidneys was ranging from 14%-75%. In another similar dosimetric study for evaluating the use of double arc VMAT for locally advanced pancreas tumors, reduced monitor units, bilateral kidney V15 dose, mean dose of liver, stomach and small bowel dose reported.…”

Section: Disclosure Statementmentioning

confidence: 98%

Volumetric Arc Therapy Seems More Promising for Sparing Organs at Risk in Adjuvant Postoperative Radiotherapy for Pancreatic Adenocarcinoma than Step-and-Shoot Intensity-Modulated Radiotherapy

Bölükbaşı¹

2017

TJ Oncol

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OBJECTIVEThe aim of the present study was to determine if volumetric modulated arc therapy (VMAT) provided superior dose distribution than intensity-modulated radiotherapy (step-and-shoot; ssIMRT) based on target volume coverage and organs at risk (OARs) doses in postoperative radiotherapy for pancreatic cancer patients. METHODSNew 4-dimensional computed tomography plans for 10 pancreatic cancer patients were created. The ssIMRT plans had 6 coplanar fields (330-0-30-60-90°) and VMAT plans were generated with 2 268-92° arcs. RESULTS VMAT CONCLUSIONVMAT provided more effective protection for bilateral kidneys and small intestine with better OAR doses, as well as for liver, with reduced high-dose volumes in this cohort. This could be investigated as more tolerable concurrent radiochemotherapy treatment with better OAR preservation.

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Dosimetric comparison of volumetric modulated arc therapy and intensity-modulated radiation therapy for pancreatic malignancies

Cited by 26 publications

References 37 publications

Stereotactic body radiation therapy planning with duodenal sparing using volumetric-modulated arc therapy vs intensity-modulated radiation therapy in locally advanced pancreatic cancer: A dosimetric analysis

Stereotactic body radiation therapy planning with duodenal sparing using volumetric-modulated arc therapy vs intensity-modulated radiation therapy in locally advanced pancreatic cancer: A dosimetric analysis

Ipsilateral kidney sparing in treatment of pancreatic malignancies using volumetric-modulated arc therapy avoidance sectors

Volumetric Arc Therapy Seems More Promising for Sparing Organs at Risk in Adjuvant Postoperative Radiotherapy for Pancreatic Adenocarcinoma than Step-and-Shoot Intensity-Modulated Radiotherapy

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