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Comparative Study
. 2014 Sep 8;15(5):4898.
doi: 10.1120/jacmp.v15i5.4898.

A dosimetric comparison of three-dimensional conformal radiotherapy, volumetric-modulated arc therapy, and dynamic conformal arc therapy in the treatment of non-small cell lung cancer using stereotactic body radiotherapy

Bradley M Rauschenbach  1 , Luke Mackowiak, Harish K Malhotra
Affiliations
Comparative Study

A dosimetric comparison of three-dimensional conformal radiotherapy, volumetric-modulated arc therapy, and dynamic conformal arc therapy in the treatment of non-small cell lung cancer using stereotactic body radiotherapy

Bradley M Rauschenbach et al. J Appl Clin Med Phys. .

Abstract

This study evaluates three-dimensional conformal radiotherapy (3D CRT), volumetric-modulated arc therapy (VMAT), and dynamic conformal arc therapy (DCAT) planning techniques using dosimetric indices from Radiation Therapy Oncology Group (RTOG) protocols 0236, 0813, and 0915 for the treatment of early-stage non-small cell lung cancer (NSCLC) using stereotactic body radiotherapy (SBRT). Twenty-five clinical patients, five per lung lobe, previously treated for NSCLC using 3D CRT SBRT under respective RTOG protocols were replanned with VMAT and DCAT techniques. All plans were compared using respective RTOG dosimetric indices. High- and low-dose spillage improved for VMAT and DCAT plans, though only VMAT was able to improve dose to all organs at risk (OARs). DCAT was only able to provide a minimal improvement in dose to the heart and ipsilateral brachial plexus. Mean bilateral, contralateral, and V20 (percentage of bilateral lung receiving at least 20 Gy dose) doses were reduced with VMAT in comparison with respective 3D CRT clinical plans. Though some of the DCAT plans had values for the above indices slightly higher than their respective 3D CRT plans, they still were able to meet the RTOG constraints. VMAT and DCAT were able to offer improved skin dose by 1.1% and 11%, respectively. Monitor units required for treatment delivery increased with VMAT by 41%, but decreased with DCAT by 26%. VMAT and DCAT provided improved dose distributions to the PTV, but only VMAT was consistently superior in sparing dose to OARs in all the five lobes. DCAT should still remain an alternative to 3D CRT in facilities that do not have VMAT or intensity-modulated radiotherapy (IMRT) capabilities.

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Figures

Figure 1
Figure 1
Schematic of a human lung with its five lobes. RUL=right upper lobe,RML=right middle lobe,RLL=right lower lobe,LUL=left upper lobe,LLL=left lower lobe.
Figure 2
Figure 2
Comparisons in the beam arrangements between 3D CRT (left), VMAT (middle), and DCAT (right) for a typical case in a transverse plane passing through the center of the tumor. Also shown is the PTV volume.
Figure 3
Figure 3
Comparison in the conformality index between 3D CRT, VMAT, and DCAT. The high value in Case 20 for 3D CRT is due to a small PTV volume
Figure 4
Figure 4
Comparison in the high‐dose location between 3D CRT, VMAT, and DCAT. The high value in Case 20 for 3D CRT is due to a small PTV volume.
Figure 5
Figure 5
Comparison in the low‐dose volume between 3D CRT, VMAT, and DCAT. The high value in Case 25 for 3D CRT is due to a small PTV volume.
Figure 6
Figure 6
Comparison in the low‐dose location between 3D CRT, VMAT, and DCAT.
Figure 7
Figure 7
Comparison in the monitor units delivered between 3D CRT, VMAT, and DCAT.
See this image and copyright information in PMC

References

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