A Prospective Trial of Helical Tomotherapy (HT) in Patients with Head and Neck Cancer (HNC): Results of Dosimetric Comparisons with Three-Dimensional Conformal Radiotherapy (3D-CRT)

Introduction. All adult medulloblastoma (AMB) patients should be treated with craniospinal irradiation (CSI) postoperatively. Because of the long irradiation range, multiple radiation fields must be designed for conventional radiotherapy technology. CSI can be completed in only one session with helical tomotherapy (HT). We evaluated the dose of HT, volumetric intensity modulated arc therapy (VMAT), and three-dimensional conformal radiotherapy (3D-CRT) of AMB and the results of 5 cases of AMB treated with HT. Methods. Complete craniospinal and posterior cranial fossa irradiation with HT, VMAT, and 3D-CRT and dose evaluation were performed. And results of 5 cases of AMB treated with HT were evaluated. Results. A large volume of tissue was exposed to low dose radiation in the organs at risk (OAR), while a small volume was exposed to high dose radiation with HT. The conformity and uniformity of the targets were good with HT and VMAT, and the volume of targets exposed to high dose with VMAT was larger than that of HT. The uniformity of 3D-CRT was also good, but the dose conformity was poor. The main toxicity was hematologic toxicity, without 4th-degree bone marrow suppression. There was 3rd-degree inhibition in the white blood cells, hemoglobin, and platelets. The three female patients suffered menstrual disorders during the course of radiation. Two female patients with heavy menstruation suffered 3rd-degree anemia inhibition, and 2 patients suffered amenorrhea after radiotherapy. Although menstrual cycle was normal, the third patient was not pregnant. Conclusion. CSI with HT is convenient for clinical practice, and the side effects are mild. With good conformity and uniformity, VMAT can also be used for selection in CSI. For poor conformity, 3D-CRT should not be the priority selection for CSI. In female patients, the ovaries should be protected.

Download Full-text

Estimating the costs of intensity-modulated and 3-dimensional conformal radiotherapy in Ontario

Current Oncology ◽

10.3747/co.23.2998 ◽

2016 ◽

Vol 23 (3) ◽

pp. 228 ◽

Cited By ~ 8

Author(s):

J.H.E Yong ◽

T. McGowan ◽

R. Redmond-Misner ◽

J. Beca ◽

P. Warde ◽

...

Keyword(s):

Prostate Cancer ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Conformal Radiotherapy ◽

System Perspective ◽

3 Dimensional ◽

Capital Costs ◽

Intensity Modulated ◽

3D Crt

Background Radiotherapy is a common treatment for many cancers, but up-to-date estimates of the costs of radiotherapy are lacking. In the present study, we estimated the unit costs of intensity-modulated radiotherapy (IMRT) and 3-dimensional conformal radiotherapy (3D-CRT) in Ontario.Methods An activity-based costing model was developed to estimate the costs of IMRT and 3D-CRT in prostate cancer. It included the costs of equipment, staff, and supporting infrastructure. The framework was subsequently adapted to estimate the costs of radiotherapy in breast cancer and head-and-neck cancer. We also tested various scenarios by varying the program maturity and the use of volumetric modulated arc therapy (VMAT) alongside IMRT.Results From the perspective of the health care system, treating prostate cancer with IMRT and 3D-CRT respectively cost $12,834 and $12,453 per patient. The cost of radiotherapy ranged from $5,270 to $14,155 and was sensitive to analytic perspective, radiation technique, and disease site. Cases of head-and-neck cancer were the most costly, being driven by treatment complexity and fractions per treatment. Although IMRT was more costly than 3D-crt, its cost will likely decline over time as programs mature and VMAT is incorporated.Conclusions Our costing model can be modified to estimate the costs of 3D-CRT and IMRT for various disease sites and settings. The results demonstrate the important role of capital costs in studies of radiotherapy cost from a health system perspective, which our model can accommodate. In addition, our study established the need for future analyses of IMRT cost to consider how VMAT affects time consumption.

Download Full-text