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Randomized Controlled Trial
. 2020 Nov 2;15(1):253.
doi: 10.1186/s13014-020-01693-2.

Report on planning comparison of VMAT, IMRT and helical tomotherapy for the ESCALOX-trial pre-study

Steffi U Pigorsch  1 , Severin Kampfer  2 , Markus Oechsner  2 , Michael C Mayinger  3 , Petra Mozes  2 , Michal Devecka  2 , Kerstin K Kessel  2 , Stephanie E Combs  2   4 , Jan J Wilkens  2
Affiliations
Randomized Controlled Trial

Report on planning comparison of VMAT, IMRT and helical tomotherapy for the ESCALOX-trial pre-study

Steffi U Pigorsch et al. Radiat Oncol. .

Abstract

Background: The ESCALOX trial was designed as a multicenter, randomized prospective dose escalation study for head and neck cancer. Therefore, feasibility of treatment planning via different treatment planning systems (TPS) and radiotherapy (RT) techniques is essential. We hypothesized the comparability of dose distributions for simultaneous integrated boost (SIB) volumes respecting the constraints by different TPS and RT techniques.

Methods: CT data sets of the first six patients (all male, mean age: 61.3 years) of the pre-study (up to 77 Gy) were used for comparison of IMRT, VMAT, and helical tomotherapy (HT). Oropharynx was the primary tumor location. Normalization of the three step SIB (77 Gy, 70 Gy, 56 Gy) was D95% = 77 Gy. Coverage (CVF), healthy tissue conformity index (HTCI), conformation number (CN), and dose homogeneity (HI) were compared for PTVs and conformation index (COIN) for parotids.

Results: All RT techniques achieved good coverage. For SIB77Gy, CVF was best for IMRT and VMAT, HT achieved highest CN followed by VMAT and IMRT. HT reached good HTCI value, and HI compared to both other techniques. For SIB70Gy, CVF was best by IMRT. HTCI favored HT, consequently CN as well. HI was slightly better for HT. For SIB56Gy, CVF resulted comparably. Conformity favors VMAT as seen by HTCI and CN. Dmean of ipsilateral and contralateral parotids favor HT.

Conclusion: Different TPS for dose escalation reliably achieved high plan quality. Despite the very good results of HT planning for coverage, conformity, and homogeneity, the TPS also achieved acceptable results for IMRT and VMAT. Trial registration ClinicalTrials.gov Identifier: NCT01212354, EudraCT-No.: 2010-021139-15. ARO: ARO 14-01.

Keywords: Combined chemoradiation therapy; Dose escalation; Head and neck cancer; Helical tomotherapy; IMRT; RT planning comparison; SIB; VMAT.

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Conflict of interest statement

No one of the authors declare conflict of interest for this work.

Figures

Fig. 1
Fig. 1
Examples of isodose distribution and DVH of VMAT, IMRT and HT for patient 2. SIB colours: SIB 77 Gy—yellow, SIB 70 Gy—orange, SIB 56 Gy—red. OAR colours: brainstem—magenta, left parotid gland—green, right parotid gland—blue, spinal cord—brown, left plexus brachialis—light green, right plexus brachialis—light blue
See this image and copyright information in PMC

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