Dosimetric comparison of two arc-based stereotactic body radiotherapy techniques for early-stage lung cancer

Huan Liu, Jingjing Ye, John J Kim, Jun Deng, Monica S Kaur, Zhe Jay Chen
Medical Dosimetry: Official Journal of the American Association of Medical Dosimetrists 2015, 40 (1): 76-81
To compare the dosimetric and delivery characteristics of two arc-based stereotactic body radiotherapy (SBRT) techniques for early-stage lung cancer treatment. SBRT treatment plans for lung tumors of different sizes and locations were designed using a single-isocenter multisegment dynamic conformal arc technique (SiMs-arc) and a volumetric modulated arc therapy technique (RapidArc) for 5 representative patients treated previously with lung SBRT. The SiMs-arc plans were generated with the isocenter located in the geometric center of patient׳s axial plane (which allows for collision-free gantry rotation around the patient) and 6 contiguous 60° arc segments spanning from 1° to 359°. 2 RapidArc plans, one using the same arc geometry as the SiMs-arc and the other using typical partial arcs (210°) with the isocenter inside planning target volume (PTV), were generated for each corresponding SiMs-arc plan. All plans were generated using the Varian Eclipse treatment planning system (V10.0) and were normalized with PTV V100 to 95%. PTV coverage, dose to organs at risk, and total monitor units (MUs) were then compared and analyzed. For PTV coverage, the RapidArc plans generally produced higher PTV D99 (by 1.0% to 3.3%) and higher minimum dose (by 2.7% to 12.7%), better PTV conformality index (by 1% to 8%), and less volume of 50% dose outside 2cm from PTV (by 0 to 20.8cm(3)) than the corresponding SiMs-arc plans. For normal tissues, no significant dose differences were observed for the lungs, trachea, chest wall, and heart; RapidArc using partial arcs produced lowest maximum dose to spinal cord. For dose delivery, the RapidArc plans typically required 50% to 90% more MUs than SiMs-arc plans to deliver the same prescribed dose. The additional intensity modulation afforded by variable gantry speed and dose rate and by overlapping arcs enabled RapidArc plans to produce dosimetrically improved plans for lung SBRT, but required more MUs (by a factor > 1.5) to deliver. The dosimetric improvements, most notably in PTV minimum dose and in dose conformality for irregularly shaped PTVs, may outweigh the increased MUs in using RapidArc. For small and peripherally located tumors, SiMs-arc produces comparable dosimetric quality and could be more efficient in both treatment planning and dose delivery.

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