Dosimetric Comparison among Volumetric-modulated Arc Therapy, Intensity-modulated Radiotherapy and Three-dimensional Conformal Radiotherapy as Adjuvant Radiotherapy for Cervical Cancer_West China Medical Journal

Authors：

 SHENYa-li ¹ , LIXia ² , ZHAOYa-qin ¹ , BAISen ² ,  XUFeng ¹

1. Department of Abdominal Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Radiological Physics Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

XUFeng, Email: XF5780@163.com

Keywords：

Cervical cancer; Volumetric-modulated arc therapy; Intensity-modulated radiotherapy; Three-dimensional conformal radiotherapy; Dosimetric comparison

DOI：

10.7507/1002-0179.20150314

Video：

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Objective To compare the dosimetric differences among the double-arc volumetric-modulated arc therapy (VMAT), 7 field intensity-modulated radiotherapy (IMRT) and 3-dimensional conformal radiotherapy (3D-CRT) techniques in treatment planning for cervical cancer as adjuvant radiotherapy. Method Fifteen patients who underwent adjuvant chemotherapy for cervical cancer between March 1st and September 30th, 2013 were chosen to be our study subjects through random sampling. Under Pinnacle 9.2 planning system, the same CT image was designed through three different techniques:VMAT, IMRT and 3D-CRT. We then compared target zone fitness index, evenness index, D_98%, D_2%, D_50% among those different techniques. Monitor unit (MU) and treatment time were also analyzed. Results Three techniques showed similar target dose coverage. The IMRT and VMAT plans achieved better target dose conformity, which reduced the V₂₀ of the pelvic, the V₅₀ of the rectum and bladder, as well as the V_40/50 of the small intestine (P<0.05). The VMAT technique showed few dosimetric advantages over the IMRT technique. VMAT technique had the advantages of less MU (P>0.05) and shorter overall treatment time (P<0.01) compared with IMRT technique. Conclusions The IMRT and VMAT plans achieve similar dose distribution to the target, and are superior to the 3D-CRT plans, in adjuvant radiotherapy for cervical cancer. VMAT technique has the advantages of less MU and shorter overall treatment time.

Citation： SHENYa-li, LIXia, ZHAOYa-qin, BAISen, XUFeng. Dosimetric Comparison among Volumetric-modulated Arc Therapy, Intensity-modulated Radiotherapy and Three-dimensional Conformal Radiotherapy as Adjuvant Radiotherapy for Cervical Cancer. West China Medical Journal, 2015, 30(6): 1096-1100. doi: 10.7507/1002-0179.20150314 Copy

1.	Peters WA, Liu PY, Barrett RJ, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix[J]. J Clin Oncol, 2000, 18(8):1606-1613.
2.	Brixey CJ, Roeske JC, Lujan AE, et al. Impact of intensity-modulated radiotherapy on acute hematologic toxicity in women with gynecologic malignancies[J]. Int J Radiat Oncol Biol Phys, 2002, 54(5):1388-1396.
3.	Mell LK, Tiryaki H, Ahn KH, et al. Dosimetric comparison of bone marrow-sparing intensity-modulated radiotherapy versus conventional techniques for treatment of cervical cancer[J]. IntJ Radiat Oncol Biol Phys, 2008, 71(5):1504-1510.
4.	Chopra S, Dora T, Chinnachamy AN, et al. Predictors of grade 3 or higher late bowel toxicity in patients undergoing pelvic radiation for cervical cancer:results from a prospective study[J]. Int J Radiat Oncol Biol Phys, 2014, 88(3):630-635.
5.	Otto K. Volumetric modulated arc therapy:IMRT in a single gantry arc[J]. Med Phys, 2008, 35(1):310-317.
6.	Bertelsen A, Hansen CR, Johansen J, et al. Single arc volumetric modulated arc therapy of head and neck cancer[J]. Radiother Oncol, 2010, 95(2):142-148.
7.	Olivera J, Penedo JM, Marin JP, et al. Localized prostate cancer:volumetric modulated arc therapy (vmat) versus intensity modulated radiation therapy (IMRT). Which one is better?[J]. Int J Radiat Oncol, 2014, 90(Supple 1):S863-S863.
8.	Shiraishi K, Yamamoto K, Haga A, et al. Volumetric modulated arc therapy (VMAT) in the treatment of localized prostate cancer:initial experience in 200 patients[J]. Int J Radiat Oncol Biol Phys, 2013, 87 (Supple 2):S380.
9.	Kamomae T, Itoh Y, Oguchi H, et al. Dosimetric influence of dental crowns on IMRT and VMAT for head and neck cancer:correlation between planned radiation doses and measured dose enhancements[J]. Int J Radiat Oncol Biol Phys, 2014, 90 (Supple 1):S871-S872.
10.	Wambersie A, Landberg T, Gahbauer R. Prescribing, recording and reporting photon beam therapy:the problem of margins (the recent ICRU recommendations, Report#62, 1999)[J]. Patras Med Phys 99, 1999:25-31.
11.	Figueira A, Monteiro A, Meireles P, et al. IMRT plan evaluation according to ICRU report 83[J]. Int J Radiat Oncol Biol Phys, 2011, 81(Supple 2):S849.
12.	Hodapp N. The ICRU report 83:regulation, documentation and communication in the fluence of modulated photon radiotherapy (MRT)[J]. Strahlentherap Onkol, 2012, 188(1):97-99.
13.	Rose BS, Aydogan B, Liang Y, et al. Normal tissue complication probability modeling of acute hematologic toxicity in cervical cancer patients treated with chemoradiotherapy[J]. Int J Radiat Oncol Biol Phys, 2011, 79(3):800-807.
14.	Hansen H, Høgdall C, Engelholm S. Radiation therapy without cisplatin for elderly cervical cancer patients[J]. Int J Radiat Oncol Biol Phys, 2014, 90(1 Suppl):S484-S485.
15.	Kim T, Cho J, Lee I, et al. Is it beneficial to increase total radiation dose in concurrent chemoradiation for cervical esophageal cancer? A single institution study[J]. Int J Radiat Oncol Biol Phys, 2014, 90 (Supple 1):S203-S204.
16.	Grzbiela H, Raczek-Zwierzycka K, Tarnawski R, et al. Is IMRT the fairest one of all? comparison of two radiation techniques in patients with advanced cervical cancer receiving concurrent radiochemotherapy[J]. Int J Gynecol Cancer, 2014, 24(9, Supple 4):529-530.
17.	Rao M, Yang W, Chen F, et al. Comparison of elekta VMAT with helical tomotherapy and fixed field IMRT:plan quality, delivery efficiency and accuracy[J]. Med Phys, 2010, 37(3):1350-1359.
18.	Cozzi L, Dinshaw KA, Shrivastava SK, et al. A treatment planning study comparing volumetric arc modulation with RapidArc and fixed field IMRT for cervix uteri radiotherapy[J]. Radiother Oncol, 2008, 89(2):180-191.
19.	Shaffer R, Nichol AM, Vollans E, et al. A comparison of volumetric modulated arc therapy and conventional intensity-modulated radiotherapy for frontal and temporal high-grade gliomas[J]. Int J Radiat Oncol Biol Phys, 2010, 76(4):1177-1184.
20.	Wagner D, Christiansen H, Wolff H, et al. Radiotherapy of malignant gliomas:comparison of volumetric single arc technique (RapidArc), dynamic intensity-modulated technique and 3D conformal technique[J]. Radiother Oncol, 2009, 93(3):593-596.

1. Peters WA, Liu PY, Barrett RJ, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix[J]. J Clin Oncol, 2000, 18(8):1606-1613.
2. Brixey CJ, Roeske JC, Lujan AE, et al. Impact of intensity-modulated radiotherapy on acute hematologic toxicity in women with gynecologic malignancies[J]. Int J Radiat Oncol Biol Phys, 2002, 54(5):1388-1396.
3. Mell LK, Tiryaki H, Ahn KH, et al. Dosimetric comparison of bone marrow-sparing intensity-modulated radiotherapy versus conventional techniques for treatment of cervical cancer[J]. IntJ Radiat Oncol Biol Phys, 2008, 71(5):1504-1510.
4. Chopra S, Dora T, Chinnachamy AN, et al. Predictors of grade 3 or higher late bowel toxicity in patients undergoing pelvic radiation for cervical cancer:results from a prospective study[J]. Int J Radiat Oncol Biol Phys, 2014, 88(3):630-635.
5. Otto K. Volumetric modulated arc therapy:IMRT in a single gantry arc[J]. Med Phys, 2008, 35(1):310-317.
6. Bertelsen A, Hansen CR, Johansen J, et al. Single arc volumetric modulated arc therapy of head and neck cancer[J]. Radiother Oncol, 2010, 95(2):142-148.
7. Olivera J, Penedo JM, Marin JP, et al. Localized prostate cancer:volumetric modulated arc therapy (vmat) versus intensity modulated radiation therapy (IMRT). Which one is better?[J]. Int J Radiat Oncol, 2014, 90(Supple 1):S863-S863.
8. Shiraishi K, Yamamoto K, Haga A, et al. Volumetric modulated arc therapy (VMAT) in the treatment of localized prostate cancer:initial experience in 200 patients[J]. Int J Radiat Oncol Biol Phys, 2013, 87 (Supple 2):S380.
9. Kamomae T, Itoh Y, Oguchi H, et al. Dosimetric influence of dental crowns on IMRT and VMAT for head and neck cancer:correlation between planned radiation doses and measured dose enhancements[J]. Int J Radiat Oncol Biol Phys, 2014, 90 (Supple 1):S871-S872.
10. Wambersie A, Landberg T, Gahbauer R. Prescribing, recording and reporting photon beam therapy:the problem of margins (the recent ICRU recommendations, Report#62, 1999)[J]. Patras Med Phys 99, 1999:25-31.
11. Figueira A, Monteiro A, Meireles P, et al. IMRT plan evaluation according to ICRU report 83[J]. Int J Radiat Oncol Biol Phys, 2011, 81(Supple 2):S849.
12. Hodapp N. The ICRU report 83:regulation, documentation and communication in the fluence of modulated photon radiotherapy (MRT)[J]. Strahlentherap Onkol, 2012, 188(1):97-99.
13. Rose BS, Aydogan B, Liang Y, et al. Normal tissue complication probability modeling of acute hematologic toxicity in cervical cancer patients treated with chemoradiotherapy[J]. Int J Radiat Oncol Biol Phys, 2011, 79(3):800-807.
14. Hansen H, Høgdall C, Engelholm S. Radiation therapy without cisplatin for elderly cervical cancer patients[J]. Int J Radiat Oncol Biol Phys, 2014, 90(1 Suppl):S484-S485.
15. Kim T, Cho J, Lee I, et al. Is it beneficial to increase total radiation dose in concurrent chemoradiation for cervical esophageal cancer? A single institution study[J]. Int J Radiat Oncol Biol Phys, 2014, 90 (Supple 1):S203-S204.
16. Grzbiela H, Raczek-Zwierzycka K, Tarnawski R, et al. Is IMRT the fairest one of all? comparison of two radiation techniques in patients with advanced cervical cancer receiving concurrent radiochemotherapy[J]. Int J Gynecol Cancer, 2014, 24(9, Supple 4):529-530.
17. Rao M, Yang W, Chen F, et al. Comparison of elekta VMAT with helical tomotherapy and fixed field IMRT:plan quality, delivery efficiency and accuracy[J]. Med Phys, 2010, 37(3):1350-1359.
18. Cozzi L, Dinshaw KA, Shrivastava SK, et al. A treatment planning study comparing volumetric arc modulation with RapidArc and fixed field IMRT for cervix uteri radiotherapy[J]. Radiother Oncol, 2008, 89(2):180-191.
19. Shaffer R, Nichol AM, Vollans E, et al. A comparison of volumetric modulated arc therapy and conventional intensity-modulated radiotherapy for frontal and temporal high-grade gliomas[J]. Int J Radiat Oncol Biol Phys, 2010, 76(4):1177-1184.
20. Wagner D, Christiansen H, Wolff H, et al. Radiotherapy of malignant gliomas:comparison of volumetric single arc technique (RapidArc), dynamic intensity-modulated technique and 3D conformal technique[J]. Radiother Oncol, 2009, 93(3):593-596.

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Dosimetric Comparison among Volumetric-modulated Arc Therapy, Intensity-modulated Radiotherapy and Three-dimensional Conformal Radiotherapy as Adjuvant Radiotherapy for Cervical Cancer

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