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Comparative Study
. 2019 Jun 13;14(1):105.
doi: 10.1186/s13014-019-1314-0.

Comparison of treatment plans between IMRT with MR-linac and VMAT for lung SABR

Jong Min Park  1   2   3   4 , Hong-Gyun Wu  1   2   3   5 , Hak Jae Kim  1   2   3   5 , Chang Heon Choi  6   7   8 , Jung-In Kim  9   10   11
Affiliations
Comparative Study

Comparison of treatment plans between IMRT with MR-linac and VMAT for lung SABR

Jong Min Park et al. Radiat Oncol. .

Abstract

Background: The aim of this study was to compare the plan quality of magnetic-resonance image-based intensity modulated radiation therapy (MRI-based-IMRT) with the MRIdian Linac system to that of volumetric modulated arc therapy (VMAT) with the TrueBeam STx system for lung stereotactic ablative radiotherapy (SABR).

Methods: A total of 22 patients with tumors located in the lower lobe were retrospectively selected for the study. For each patient, both the MRI-based-IMRT and VMAT plans were generated using an identical CT image set and identical structures with the exception of the planning target volume (PTV). The PTVs of the MRI-based-IMRT were generated by adding an isotropic margin of 3 mm from the gross tumor volume, whereas those of VMAT were generated by adding an isotropic margin of 5 mm from the internal target volume. For both the MRI-based-IMRT and VMAT, the prescription doses to the PTVs were 60 Gy in four fractions.

Results: The average PTV volume of the MRI-based-IMRT was approximately 4-times smaller than that of VMAT (p < 0.001). The maximum dose to the bronchi for the MRI-based-IMRT was smaller than that for the VMAT (20.4 Gy versus 24.2 Gy, p < 0.001). In addition, V40Gy of the rib for the MRI-based-IMRT was smaller than that for the VMAT (1.8 cm3 versus 7.7 cm3, p = 0.008). However, the maximum doses to the skin and spinal cord for the MRI-based-IMRT (33.0 Gy and 14.5 Gy, respectively) were larger than those for the VMAT (27.8 Gy and 11.0 Gy, respectively) showing p values of less than 0.02. For the ipsilateral lung, the mean dose, V20Gy, V10Gy, and V5Gy for the MRI-based-IMRT were smaller than those for the VMAT (all with p < 0.05). For the contralateral lung, V5Gy, V10Gy, D1500cc, and D1000cc for the MRI-based-IMRT were larger than those for the VMAT (all with p < 0.05). The mean dose and V50% of the whole body for the MRI-based-IMRT were smaller than those for the VMAT (0.9 Gy versus 1.2 Gy, and 78.7 cm3 versus 103.5 cm3, respectively, all at p < 0.001).

Conclusions: The MRI-based-IMRT using the MRIdian Linac system could reduce doses to bronchi, rib, ipsilateral lung, and whole body compared to VMAT for lung SABR when the tumor was located in the lower lobe.

Keywords: MR-IGRT; MR-linac; Planning study; SABR; VMAT.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Representative patient dose distributions of volumetric modulated arc therapy and magnetic resonance image-based intensity modulated radiation therapy. Dose distributions in the axial, coronal, and sagittal planes of volumetric modulated arc therapy (VMAT) of representative patients, namely, patients A (a) and B (c), are shown. Those of magnetic resonance image-based intensity modulated radiation therapy (MRI-based IMRT) using a linear accelerator with a magnetic resonance imaging system are shown for patients A (b) and B (d). The planning target volume of VMAT were generated by adding an isotropic margin of 5 mm from the internal target volume, whereas those of MRI-based IMRT were generated by adding an isotropic margin of 3 mm from the gross tumor volume
Fig. 2
Fig. 2
Representative dose-volume histograms of the target volume and organs at risk of volumetric modulated arc therapy and magnetic resonance image-based intensity modulated radiation therapy plans. Dose volume histograms of the planning target volume, both lungs, and whole body from the volumetric modulated arc therapy and magnetic resonance image-based intensity modulated radiation therapy plans of representative patients, namely, patients A (a) and B (c) are shown. Those of organs at risk of patients A (b) and B (d) are also shown
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