Abstract
Patients with incurable lung cancer often present with debilitating symptoms that require urgent palliative radiotherapy. Volumetric modulated arc therapy (VMAT) provides several dosimetric advantages compared to basic non-conformal techniques, but involves complex planning resulting in a slower turn-around time for treatment. A simplified planning technique known as ‘rapid VMAT’ was developed with an aim to deliver palliative treatment to patients within 48 hours. The purpose of this study was to prospectively compare the dosimetric quality of rapid VMAT plans to standard VMAT plans. Fourteen consecutive rapid VMAT cases were re-planned de novo as per standard VMAT planning guidelines. Planning target volume (PTV) and organs at risk (OARs) were then compared. PTV coverage and dose to OARs including the spinal canal, lung, heart, and esophagus were similar between rapid and standard VMAT. Each plan was ready for treatment within 48 hours of the CT simulation. This study describes an expedited process for which palliative radiotherapy can be delivered to lung tumors with a similar robust quality that is provided for curative intent VMAT radiotherapy plans.
Highlights
Lung cancer is the most commonly diagnosed cancer worldwide [1]
While volumetric modulated arc therapy (VMAT) is associated with several dosimetric advantages that may translate into improved outcomes for patients, the technique involves complex planning and quality assurance that can strain department resources and result in slower turn-around times for patient treatments, which may often be unacceptable for symptomatic palliative patients
Our study demonstrated that a rapid VMAT technique produced palliative radiotherapy plans for lung tumors of similar quality to standard VMAT with excellent tumor coverage, and low doses to normal tissues
Summary
Lung cancer is the most commonly diagnosed cancer worldwide [1]. The majority of patients have advanced, incurable disease at diagnosis and often present with debilitating symptoms, such as dyspnea, pain, and hemoptysis, that frequently require urgent palliative radiotherapy [2,3]. As the use of volumetric modulated arc therapy (VMAT) becomes more widespread, interest in utilizing this advanced technique for treatments with palliative intent in an effort to decrease toxicity has grown [5,6,7]. In an effort to increase capacity to provide timely VMAT to palliative lung cancer patients, a simplified planning technique known as ‘rapid VMAT’ was developed with an aim to deliver treatment to patients within 48 hours. The purpose of this study was to prospectively compare the dosimetric quality of rapid VMAT plans to standard VMAT plans for patients receiving palliative radiotherapy to lung tumors, and to assess its impact on the department workload
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