Abstract
PurposeTo investigate the feasibility of constant dose rate volumetric modulated arc therapy (CDR-VMAT) in the treatment of nasopharyngeal cancer (NPC) patients and to introduce rotational arc radiotherapy for linacs incapable of dose rate variation.Materials and methodsTwelve NPC patients with various stages treated previously using variable dose rate (VDR) VMAT were enrolled in this study. CDR-VMAT, VDR-VMAT and mutlicriteria optimization (MCO) VMAT plans were generated for each patient on RayStation treatment planning system with identical objective functions and the dosimetric differences among these three planning schemes were evaluated and compared. Non dosimetric parameters of optimization time, delivery time and delivery accuracy were also evaluated.ResultsThe planning target volume of clinical target volume (PTV-CTV) coverage of CDR-VMAT was a bit inferior to those of VDR- and MCO-VMAT. The V93 (p = 0.01) and V95 (percent volume covered by isodose line) (p = 0.04) for CDR-VMAT, VDR-VMAT and MCO-VMAT were 98.74% ± 0.31%, 99.76% ± 0.16%, 99.38% ± 0.43%, and 98.40% ± 0.48%, 99.53% ± 0.28%, 99.07% ± 0.52%, respectively. However, the CDR-VMAT showed a better dose homogeneity index (HI) (p = 0.01) in PTV-CTV. No significant difference in other target coverage parameters was observed. There was no significant difference in OAR sparing among these three planning schemes except for a higher maximum dose (Dmax) on the brainstem for CDR-VMAT. The brainstem Dmax of CDR-VMAT, VDR-VMAT and MCO-VMAT were 54.26 ± 3.21 Gy, 52.19 ± 1.65 Gy, and 52.79 ± 4.77 Gy, respectively. The average delivery time (p < 0.01) and the average percent γ passing rates (p = 0.02) of CDR-VMAT, VDR-VMAT and MCO-VMAT were 7.01 ± 0.43 min, 4.75 ± 0.07 min, 4.01 ± 0.28 min, and 95.75% ± 2.57%, 97.65% ± 1.45%, 97.36% ± 2.45%, respectively.ConclusionCDR-VMAT offers an additional option of rotational arc radiotherapy for linacs incapable of dose rate variation with a lower initial cost. Its plan quality was acceptable but should be thoroughly checked compared with VDR-VMAT and MCO-VMAT in the treatment of NPC.
Highlights
Due to its dose painting ability, intensity-modulated radiation therapy (IMRT), which is able to deliver more conformal radiation to the tumor than earlier techniques and spare the surrounding normal tissue from unnecessary exposure [1], has been accepted as a standard treatment modality for nasopharyngeal cancer (NPC) [2].Disadvantages of IMRT are the longer required irradiation time and the greater total number of monitor units (MUs) compared with conventional methods [1]
The volumes receiving 93% (V93) (p = 0.01) and V95 (p = 0.04) for Constant dose rate (CDR)-volumetric-modulated arc therapy (VMAT), variable dose rate (VDR)-VMAT and mutlicriteria optimization (MCO)-VMAT were 98.74% ± 0.31%, 99.76% ± 0.16%, 99.38% ± 0.43%, and 98.40% ± 0.48%, 99.53% ± 0.28%, 99.07% ± 0.52%, respectively
CDR-VMAT offers an additional option of rotational arc radiotherapy for linacs incapable of dose rate variation with a lower initial cost
Summary
Disadvantages of IMRT are the longer required irradiation time and the greater total number of monitor units (MUs) compared with conventional methods [1]. An increase in the total number of MUs may expose the patients to the risk of low-dose irradiation owing to increased leakage [3]. To use the VMAT approach, the hardware and software systems of the radiation treatment planning system (TPS), as well as the linear accelerator (linac), must be upgraded. Compared with fixed field IMRT, the potential advantages of CDR with a great reduction in irradiation time and clinical acceptable dose distribution has been reported [5,7]. For institutions that do not currently perform VDR-VMAT, CDR-VMAT may be a useful option
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