Versus Volumetric Modulated Arc Therapy Research Articles

Longitudinal Assessment of Quality of Life in Nasopharyngeal Cancer Patients Treated with Intensity-Modulated Proton Therapy and Volumetric Modulated Arc Therapy at Different Time Points.

This retrospective cohort study aims to compare the quality of life (QoL) in patients with nasopharyngeal cancer (NPC) treated with intensity-modulated proton therapy (IMPT) versus volumetric modulated arc therapy (VMAT) at different time points. We conducted a longitudinal assessment of QoL on 287 newly diagnosed NPC patients (IMPT: 41 and VMAT: 246). We collected outcomes of global QoL, functional QoL, C30 symptoms, and HN35 symptoms from EORTC QLQ-C30 and QLQ-HN35 questionnaires at pre-radiotherapy, during radiotherapy (around 40 Gy), 3 months post radiotherapy, and 12-months post radiotherapy (RT). The generalized estimating equation was utilized to interpret the group effect, originating from inherent group differences; time effect, attributed to RT effects over time; and interaction of the group and time effect. IMPT demonstrated superior mean dose reductions in 12 of the 16 organs at risk compared to VMAT, including a significant (>50%) reduction in the oral cavity and larynx. Both groups exhibited improved scores of global QoL, functional QoL, and C30 symptoms at 12 months post RT compared to the pre-RT status. Regarding global QoL and C30 symptoms, there was no interaction effect of group over time. In contrast, significant interaction effects were observed on functional QoL (p = 0.040) and HN35 symptoms (p = 0.004) during RT, where IMPT created an average of 7.5 points higher functional QoL and 10.7 points lower HN35 symptoms than VMAT. Compared to VMAT, dose reduction attributed to IMPT could translate into better functional QoL and HN35 symptoms, but the effect is time dependent and exclusively observed during the RT phase.

Comparative Analysis of Parotid Doses in Tomotherapy Versus Volumetric Modulated Arc Therapy for Head and Neck Cancer Patients Undergoing Bilateral Neck Irradiation: A Non-randomized, Prospective, Dosimetric and Clinical Study

Background and Objectives: Xerostomia, a common side effect of head and neck radiation therapy, significantly impacts subjective well-being and quality of life. Its severity depends on the radiation dosage received by the parotids. Advanced techniques like Volumetric Modulated Arc Therapy (VMAT) and Tomotherapy offer improved parotid sparing. This prospective, non-randomized, double arm, dosimetric, and clinical study aims to compare parotid dosages between Tomotherapy and VMAT (Rapid Arc) in head and neck cancer patients undergoing bilateral neck irradiation. Methods: Fifty-two eligible patients were included, with 26 treated by Tomotherapy and 26 by VMAT. Plans were cross planned between the two techniques while maintaining similar Planning Target Volume (PTV) coverage. Bilateral parotid dosages were evaluated, and clinical xerostomia assessment utilized the Xerostomia Questionnaire (XQ) and Radiation Therapy Oncology Group (RTOG) scoring criteria. Statistical analysis employed the paired t-test. Results: Both right and left parotids received significantly lower mean doses on Tomotherapy (21.23Gy ± 4.429) compared to VMAT (23.26Gy ± 4.531) (p < 0.001). XQ scores and RTOG scores did not show statistically significant differences between the two arms at both follow-ups. Tomotherapy demonstrated better parotid sparing, translating into reduced acute salivary gland morbidities. Conclusion: This study highlights Tomotherapy's superiority in parotid sparing over Rapid Arc (VMAT), leading to clinically relevant reductions in xerostomia. Notably, oral cavity cancer patients exhibited higher xerostomia scores, emphasizing the importance of minor salivary glands. Long-term follow-up, extending to at least 2 years post-radiotherapy, is crucial for a comprehensive assessment of the technique's advantage in reducing xerostomia and improving quality of life.

Dosimetric Evaluation of Intensity Modulated Radiotherapy Versus Volumetric Modulated Arc Therapy for Flap-Sparing Hypofractionated Postmastectomy Radiotherapy

Dosimetric Evaluation of Intensity Modulated Radiotherapy Versus Volumetric Modulated Arc Therapy for Flap-Sparing Hypofractionated Postmastectomy Radiotherapy

74: Dosimetric Evaluation of Intensity Modulated Radiotherapy Versus Volumetric Modulated Arc Therapy for Flap-Sparing Hypofractionated Post-Mastectomy Radiotherapy

74: Dosimetric Evaluation of Intensity Modulated Radiotherapy Versus Volumetric Modulated Arc Therapy for Flap-Sparing Hypofractionated Post-Mastectomy Radiotherapy

PT114 - Robot-assisted radical prostatectomy (RARP) versus volumetric modulated arc therapy (VMAT) in cT1-4N0M0 prostate cancer

PT114 - Robot-assisted radical prostatectomy (RARP) versus volumetric modulated arc therapy (VMAT) in cT1-4N0M0 prostate cancer

A Retrospective Review on Stereotactic Radiosurgery Cases Planned with Dynamic Conformal Arcs Versus Volumetric Modulated Arc Therapy

This study aimed to acquire an average value of plan quality metrics by retrospectively analyzing past stereotactic radiosurgery (SRS) treatment plans. The study was also designed to compare the plan quality metrics between single-target Dynamic Conformal Arc (DCA) and multi-target Volumetric Modulated Arc Therapy (VMAT) plans. A total of 253 LINAC-based SRS plans treated in 2017 at our institution were reviewed. A total of 605 lesions were included in these plans as treatment targets. 156 plans were generated with a DCA technique treating single target in each plan, and 97 plans used a VMAT technique to treat multiple targets simultaneously in a single plan. The prescription dose was normalized to 20Gy for all plans for this analysis. Two plan quality metrics, tumor Conformity Index (CI) and normal tissue volume receiving more than 12Gy (V12Gy), were calculated for each target. The results were stratified based on target size and compared between different techniques. For multi-targets VMAT plans, the distance of a target to the nearest other target and the number of targets being treated in the same plan were calculated for each target to evaluate their impact on V12Gy. For the subgroups of target volume < 0.2cc, 0.2-0.5cc, 0.5-1.0cc, 1.0-2.0cc, and 2.0-4.0cc, the mean (±SD) CI were 2.1 (±0.3), 1.9 (±0.2), 1.8 (±0.3), 1.6 (±0.2), and 1.6 (±0.1), respectively, in DCA plans and 1.8 (±0.4), 1.5 (±0.2), 1.4 (±0.2), 1.3 (±0.2), and 1.3 (±0.1), respectively, in VMAT plans. The mean V12Gy were 1.2cc, 1.9cc, 3.5cc, 5.2cc, and 7.4cc, respectively, in DCA plans and 1.3cc, 2.2cc, 3.2cc, 4.7cc, and 7.8cc, respectively, in VMAT plans. The V12Gy for a target in VMAT plan did not show apparent dependence on the distance between targets or the total number of targets in single VMAT plan. The average performance level of CI and V12Gy were established based on previous cases and can be used as benchmark for future SRS planning. The multi-target VMAT plans produced consistently lower CI and kept the normal tissue 12Gy per target comparable to DCA plans.

Novel Dosimetric Comparison of Intensity Modulated Radiation Therapy Versus Volumetric Modulated Arc Therapy Delivery When Using Dental Stents for Protection of Oral Mucosa

Novel Dosimetric Comparison of Intensity Modulated Radiation Therapy Versus Volumetric Modulated Arc Therapy Delivery When Using Dental Stents for Protection of Oral Mucosa

Simultaneous Integrated Boost (SIB) for Treatment of Gynecological Malignancies: Intensity Modulated Radiation Therapy (IMRT) Versus Volumetric Modulated Arc Therapy (VMAT)

Simultaneous Integrated Boost (SIB) for Treatment of Gynecological Malignancies: Intensity Modulated Radiation Therapy (IMRT) Versus Volumetric Modulated Arc Therapy (VMAT)

A comparative study of distribution of residual cancer cells in the bowel wall after preoperative three-dimensional conformal radiotherapy versus volumetric modulated arc therapy with concurrent chemotherapy in treatment of locally advanced rectum cancer

Objective To compare the distribution of residual cancer cells (RCC) in each layer of bowl wall after preoperative three-dimensional conformal radiotherapy (3DCRT) versus volumetric modulated arc therapy (VMAT) combined with concurrent chemotherapy, and to investigate the effect of different radiotherapy techniques on the distribution of RCC. Methods A total of 334 patients with locally advanced rectum cancer (LARC) who were admitted to our hospital from May 2007 to April 2013 were enrolled as subjects. In those patients, 172 received preoperative 3DCRT (46 Gy/23 F) with concurrent chemotherapy and 162 received VMAT (50 Gy/25 F) with concurrent chemotherapy. There was no significant difference in the distribution of clinical stage Ⅱ or Ⅲ between the 3DCRT group and VMAT group. All the RCCs in different layers of surgical specimens were evaluated pathologically. Between-group comparison of data was made by Pearson Chi-Square and Fisher's exact test. Results There were no significant differences in ypT, ypN, or ypTNM staging between the two groups (P values>0.05). In the 226 patients with ypT2-4 disease, the proportion of RCC in the mucosa, submucosa, muscularis propria, and subserosa/perirectal fat was 34.1%, 43.8%, 73.5%, and 69.0%, respectively. In patients with ypT2-4, pN+ , cN+ , or cT4 disease, compared with the VMAT group, the 3DCRT group had significantly higher proportion of RCCs in the mucosa (47.9% vs. 18.1%, 54.5% vs. 17.2%, 39.8% vs. 15.3%, 41.3% vs. 14.3%; P=0.000, 0.001, 0.000, 0.000) and submucosa (50.4% vs. 36.2%, 56.8% vs. 27.6%, 43.0% vs.26.6%, 45.3% vs. 27.5%; P=0.032, 0.014, 0.006, 0.017). In patients with pN0 or cT3 disease, the 3DCRT group had a significantly higher proportion of RCCs in the mucosa than the VMAT group (28.1% vs. 12.9%, P=0.002; 29.5% vs. 13.2%, P=0.015). In patients with ypT2-4, pN0/pN+ , cT3/cT4, or cN0/cN+ disease, there were no significant differences in the proportion of RCCs in the muscularis propria or subserosa/perirectal fat between the two groups (P values>0.05). Conclusions After neoadjuvant chemoradiotherapy, most RCCs reside in the muscularis propria and subserosa/perirectal fat of the bowl wall. There are no significant differences in the distribution of most RCCs in the bowel wall or postoperative pathological staging between patients undergoing different radiotherapy techniques. Key words: Rectum neoplasms/three-dimensional conformal radiotherapy; Rectum neoplasms/volumetric modulated arc therapy; Rectum neoplasms/neoadjuvant chemoradiotherapy; Residual cancer cell; Pathological staging

Can advanced new radiation therapy technologies improve outcome of high grade glioma (HGG) patients? analysis of 3D-conformal radiotherapy (3DCRT) versus volumetric-modulated arc therapy (VMAT) in patients treated with surgery, concomitant and adjuvant chemo-radiotherapy

BackgroundTo assess the impact of volumetric-modulated arc therapy (VMAT) compared with 3D-conformal radiotherapy (3DCRT) in patients with newly diagnosed high grade glioma in terms of toxicity, progression free survival (PFS) and overall survival (OS).MethodsFrom March 2004 to October 2014, 341 patients underwent surgery followed by concomitant and adjuvant chemo-radiotherapy. From 2003 to 2010, 167 patients were treated using 3DCRT; starting from 2011, 174 patients underwent VMAT. The quantitative evaluation of the treatment plans was performed by means of standard dose volume histogram analysis. Response was recorded using the Response Assessment in Neuro-Oncology (RANO) criteria and toxicities graded according to Common Terminology Criteria for Adverse Event version 4.0.ResultsBoth techniques achieved an adequate dose conformity to the target. The median follow up time was 1.3 years; at the last observation 76 patients (23.4 %) were alive and 249 (76.6 %) dead (16 patients were lot to follow-up). For patients who underwent 3DCRT, the median PFS was 0.99 ± 0.07 years (CI95: 0.9–1.1 years); the 1 and 3 years PFS were, 49.6 ± 4 and 19.1 ± 3.1 %. This shall be compared, respectively, to 1.29 ± 0.13 years (CI95: 1.01–1.5 years), 60.8 ± 3.8, and 29.7 ± 4.6 % for patients who underwent VMAT (p = 0.02). The median OS for 3DCRT patients was 1.21 ± 0.09 years (CI95:1.03–1.3 years); 1 and 5 year OS was, 63.3 ± 3.8 and 21.5 ± 3.3 %. The corresponding results for 3DRCT patients were 1.56 ± 0.09 years (CI95:1.37–1.74 years), 73.4 ± 3.5, 30 ± 4.6 % respectively (p < 0.01). In both groups, prognostic factors conditioning PFS and OS were age, gender, KPS, histology and extent of resection (EOR).ConclusionsVMAT resulted superior to 3DCRT in terms of dosimetric findings and clinical results.

Intrafraction Motion in Stereotactic Body Radiation Therapy for Non-Small Cell Lung Cancer: Intensity Modulated Radiation Therapy Versus Volumetric Modulated Arc Therapy

Stereotactic body radiation therapy (SBRT) for early-stage inoperable non-small cell lung cancer (NSCLC) patients delivers high doses that require high-precision treatment. Typically, image guidance is used to minimize day-to-day target displacement, but intrafraction position variability is often not corrected. Currently, volumetric modulated arc therapy (VMAT) is replacing intensity modulated radiation therapy (IMRT) in many departments because of its shorter delivery time. This study aimed to evaluate whether intrafraction variation in VMAT patients is reduced in comparison with patients treated with IMRT. NSCLC patients (197 IMRT and 112 VMAT) treated with a frameless SBRT technique to a prescribed dose of 3×18Gy were evaluated. Image guidance for both techniques was identical: pretreatment cone beam computed tomography (CBCT) (CBCTprecorr) for setup correction followed immediately before treatment by postcorrection CBCT (CBCTpostcorr) for verification. Then, after either a noncoplanar IMRT technique or a VMAT technique, a posttreatment (CBCTpostRT) scan was acquired. The CBCTpostRT and CBCTpostcorr scans were then used to evaluate intrafraction motion. Treatment delivery times, systematic (Σ) and random (σ) intrafraction variations, and associated planning target volume (PTV) margins were calculated. The median treatment delivery time was significantly reduced by 20minutes (range, 32-12minutes) using VMAT compared with noncoplanar IMRT. Intrafraction tumor motion was significantly larger for IMRT in all directions up to 0.5mm systematic (Σ) and 0.7mm random (σ). The required PTV margins for IMRT and VMAT differed by less than 0.3mm. VMAT-based SBRT for NSCLC was associated with significantly shorter delivery times and correspondingly smaller intrafraction motion compared with noncoplanar IMRT. However, the impact on the required PTV margin was small.

Quality of Life in Nasopharyngeal Cancer (NPC) Patients: Study of Salivary Flow Recovery Pattern on Xerostomia Improvement for Intensity Modulated Radiation Therapy (IMRT) Versus Volumetric Modulated Arc Therapy (VMAT)

Quality of Life in Nasopharyngeal Cancer (NPC) Patients: Study of Salivary Flow Recovery Pattern on Xerostomia Improvement for Intensity Modulated Radiation Therapy (IMRT) Versus Volumetric Modulated Arc Therapy (VMAT)

A Dosimetric Comparison of Helical Tomotherapy Versus Volumetric Modulated Arc Therapy in Radiosurgery for Multiple Intracranial Lesions

A Dosimetric Comparison of Helical Tomotherapy Versus Volumetric Modulated Arc Therapy in Radiosurgery for Multiple Intracranial Lesions

SU-E-T-593: VMAT Vs. IMRT for Treatment of Neoplasms of the Brain: Dosimetric Quality and Delivery.

A retrospective study was performed to determine any dosimetric or delivery benefits for treatment planning with intensity-modulated radiotherapy (IMRT) versus volumetric-modulated arc therapy (VMAT) for the treatment of brain neoplasms. Eighteen patients treated with modulated brain radiotherapy treatments were included in this study (primary treatment volumes of 15.3 to 374.9 cc). IMRT and VMAT plans were generated for each patient using the same criteria for prescription coverage and normal tissue sparing. IMRT optimizations ranged from five to seven fields and VMAT from two to four arcs. Plans were generated with Varian Eclipse treatment planning system utilizing AAA-8615 dose calculation algorithm. VMAT optimizations provided limited dosimetric advantages versus IMRT. VMAT provided superior treatment volume coverage (volumes receiving 95%, 100% of prescription dose (V95%, V100%)) over IMRT, but differences were not statistically significant (paired t-test p > 0.05). Relative maximum dose values, conformity and homogeneity indices also exhibited no statistical differences. IMRT plans resulted in similar mean brain minus treatment volume (Brain- TV) dose (mean = 1460.1 vs. 1506.3 cGy; p = 0.056). The volume of Brain- TV receiving 40Gy was lower for VMAT than IMRT (average = 38.96 vs. 44.97 cc; p = 0.050). Maximum skin dose was lower for VMAT (mean = 4568.8 vs. 5063.3cGy; p = 0.006), as well as skin V20Gy (6.56% vs 7.69%; p = 0.027) and V40Gy (0.56% vs. 0.35%; p = 0.017). VMAT plans required fewer fields along with fewer MU than IMRT (mean = 388.2 vs. 721.1 MU, respectively), allowing for approximately 20% faster delivery times. VMAT treatments significantly reduced treatment time due to reduced MU and fewer fields. Certain skin and Brain-TV high dose spread parameters were superior for VMAT as compared to IMRT plans. All other dosimetric parameters tested were statistically equivalent for VMAT and IMRT techniques.

A Treatment Planning and Acute Toxicity Comparison of Two Pelvic Nodal Volume Delineation Techniques and Delivery Comparison of Intensity-Modulated Radiotherapy Versus Volumetric Modulated Arc Therapy for Hypofractionated High-Risk Prostate Cancer Radiotherapy

To perform a comparison of two pelvic lymph node volume delineation strategies used in intensity-modulated radiotherapy (IMRT) for high risk prostate cancer and to determine the role of volumetric modulated arc therapy (VMAT). Eighteen consecutive patients accrued to an ongoing clinical trial were identified according to either the nodal contouring strategy as described based on lymphotropic nanoparticle-enhanced magnetic resonance imaging technology (9 patients) or the current Radiation Therapy Oncology Group (RTOG) consensus guidelines (9 patients). Radiation consisted of 45 Gy to prostate, seminal vesicles, and lymph nodes, with a simultaneous integrated boost to the prostate alone, to a total dose of 67.5 Gy delivered in 25 fractions. Prospective acute genitourinary and gastrointestinal toxicities were compared at baseline, during radiotherapy, and 3 months after radiotherapy. Each patient was retrospectively replanned using the opposite method of nodal contouring, and plans were normalized for dosimetric comparison. VMAT plans were also generated according to the RTOG method for comparison. RTOG plans resulted in a significantly lower rate of genitourinary frequency 3 months after treatment. The dosimetric comparison showed that the RTOG plans resulted in both favorable planning target volume (PTV) coverage and lower organs at risk (OARs) and integral (ID) doses. VMAT required two to three arcs to achieve adequate treatment plans, we did not observe consistent dosimetric benefits to either the PTV or the OARs, and a higher ID was observed. However, treatment times were significantly shorter with VMAT. The RTOG guidelines for pelvic nodal volume delineation results in favorable dosimetry and acceptable acute toxicities for both the target and OARs. We are unable to conclude that VMAT provides a benefit compared with IMRT.