Planning evaluation of a novel volume-based algorithm for personalized optimization of lung dose in VMAT for esophageal cancer

Abstract

Radiotherapy treatment planning (RTP) is time-consuming and labor-intensive since medical physicists must devise treatment plans carefully to reduce damage to tissues and organs for patients. Previously, we proposed the volume-based algorithm (VBA) method, providing optimal partial arcs (OPA) angle to achieve the low-dose volume of lungs in dynamic arc radiotherapy. This study aimed to implement the VBA for esophageal cancer (EC) patients and compare the lung dose and delivery time between full arcs (FA) without using VBA and OPA angle using VBA in volumetric modulated arc therapy (VMAT) plans. We retrospectively included 30 patients diagnosed with EC. RTP of each patient was replanned to 4 VMAT plans, including FA plans without (FA-C) and with (FA + C) dose constraints of OARs and OPA plans without (OPA-C) and with (OPA + C) dose constraints of OARs. The prescribed dose was 45 Gy. The OARs included the lungs, heart, and spinal cord. The dose distribution, dose-volume histogram, monitor units (MUs), delivery time, and gamma passing rates were analyzed. The results showed that the lung V5 and V10 in OPA + C plans were significantly lower than in FA + C plans (p < 0.05). No significant differences were noted in planning target volume (PTV) coverage, lung V15, lung V20, mean lung dose, heart V30, heart V40, mean heart dose, and maximal spinal cord dose between FA + C and OPA + C plans. The delivery time was significantly longer in FA + C plans than in OPA + C plans (237 vs. 192 s, p < 0.05). There were no significant differences between FA + C and OPA + C plans in gamma passing rates. We successfully applied the OPA angle based on the VBA to clinical EC patients and simplified the arc angle selection in RTP. The VBA could provide a personalized OPA angle for each patient and effectively reduce lung V5, V10, and delivery time in VMAT.

Combined modality therapy for patients with esophageal squamous cell carcinoma: Radiation dose and survival analyses

“…Several randomized controlled studies have demonstrated that DCCRT for ESCC may offer a comparable survival to standard surgery, 4,16 especially in patients who respond to chemoradiation. Although modern radiotherapy techniques using IMRT or VMAT which provide significantly better normal tissue sparing have been widely applied in recent years, the optimal radiation dose for esophageal cancer still remains controversial 8,10,17–20 …”

“…Although modern radiotherapy techniques using IMRT or VMAT which provide significantly better normal tissue sparing have been widely applied in recent years, the optimal radiation dose for esophageal cancer still remains controversial. 8,10,[17][18][19][20] F I G U R E 2 Radiation dose-survival curve of the patients receiving DCCRT. Based on the radiation dose, patients were divided into the 45-50, 50-55, 55-60 and 60-65 Gy groups.…”

“…Although modern radiotherapy techniques using IMRT or VMAT which provide significantly better normal tissue sparing have been widely applied in recent years, the optimal radiation dose for esophageal cancer still remains controversial. 8 , 10 , 17 , 18 , 19 , 20 …”