Volumetric Modulated Arc Therapy for Head and Neck Cancer: A Dosimetric and Treatment Planning Comparison with Intensity Modulated Radiotherapy Techniques

Abstract

Introduction: Traditional Intensity Modulated Radiotherapy (IMRT) techniques used many beam angles; the result of this is significant increase in beam on time as well as Monitor Units (MU) also. Due to all of these there is a need of faster treatment modality to increase the patient comfort and lesser organ movement. Aim: To compare the triple arc RapidArc technique with nine field IMRT techniques for different head and neck cancer, focusing on target coverage and dose received by the Organs At Risk (OARs). Materials and Methods: Retrospectively, Computed Tomography (CT) datasets of 20 patients of Squamous Cell Carcinoma (SCC) of the Oro-pharynx and Hypo-pharynx treated during January 2019 to December 2019 were chosen for this study. For every patient, two different treatment plans were created, one by using the triple arc RapidArc technique and others by using nine fixed fields IMRT technique. For Planning Target Volume (PTV), the dose volume parameters D98% and D2% (dose received by the 98%, and 2% of the volume), homogeneity index, and Conformity Index (CI) were evaluated for dosimetric comparison. For OARs, the analysis included the mean dose, the maximum dose expressed as D2%. Additionally, the Beam On Time (BOT) and the number of MUs were analysed. A paired two-tailed t-test was performed to compare the RapidArc technique with the IMRT technique for radiotherapy treatment of different head and neck cancers. The p-value <0.05 was considered for the significance of statistical inferences. Results: Comparable target coverage and better sparing of OARs were achieved with the RapidArc technique in comparison to IMRT. Homogeneity and conformity were also in favour of the RapidArc plan. The dosimetric results with I’MatriXX measurements of RapidArc plans were similar to IMRT plans. All detector points passed 3 mm and 3% gamma criteria for IMRT plans and also for RapidArc plans. Conclusion: RapidArc is a faster and precise treatment technique. RapidArc provides better target coverage with good OARs sparing. Most significant change occurs in the number of MUs and treatment time, which is much lesser in RapidArc.