scholarly journals Is IMRT or VMAT superior or inferior to 3D conformal therapy in the treatment of lung cancer? A brief literature review

2021 ◽  
pp. 1-5
Author(s):  
Kazi T. Afrin ◽  
Salahuddin Ahmad
Keyword(s):  
Lung Cancer ◽  
Literature Review ◽  
Treatment Time ◽  
Volumetric Modulated Arc Therapy ◽  
Target Volume ◽  
Patient Comfort ◽  
Tumour Control ◽  
Intrafraction Motion ◽  
Conformal Therapy ◽  
3D Crt

Abstract Aim: To identify treatment outcome, dose uniformity, treatment time, toxicity among 3D conformal therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT) for non-small-cell lung cancer (NSCLC) based on literature review. Methods: A literature search was conducted using PubMed/MEDLINE, BMC—part of Springer Nature, Google Scholar and iMEDPub Ltd with the following keywords for filtering: 3D-CRT, IMRT, VMAT, lung cancer, local control and radiobiology. A total of 14 publications were finally selected for the comparison of 3D-CRT, IMRT and VMAT to determine which technique is superior or inferior among these three. Results: Compared to 3D-CRT, IMRT delivers more precise treatment, has better conformal dose coverage to planning target volume (PTV) that covers gross tumour with microscopic extension, respiratory tumour motion and setup margin. 3D-CRT has large number of limitations: low overall survival (OS), large toxicity, secondary malignancies. Conclusions: It is difficult to choose the best technique for treating NSCLC due to patient conditions and technique availability. A high-precision treatment may improve tumour control probability (TCP) and patient’s quality of life. VMAT, whether superior or not, needs more clinical trials to treat NSCLC and requires longer dose optimisation time with the greatest benefit of rapid treatment delivery, improved patient comfort, reduced intrafraction motion and increased patient throughput compared to IMRT and 3D-CRT.

3D conformal, IMRT and VMAT for the treatment of head and neck cancer: a brief literature review

2020 ◽  
pp. 1-4
Author(s):  
Kazi T. Afrin ◽  
Salahuddin Ahmad
Keyword(s):  
Radiation Therapy ◽  
Head And Neck Cancer ◽  
Literature Review ◽  
Head And Neck ◽  
Neck Cancer ◽  
Treatment Time ◽  
Organs At Risk ◽  
Patient Comfort ◽  
High Dose ◽  
3D Crt

Abstract Aim: The objective of this study has been to identify monitor unit (MU) and treatment time variations, volume coverage dissimilarity among 3D conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) treatment plans for head and neck cancer (HNC) based on literature review. Methods: A number of HNC cases were studied with the investigation of conformity and homogeneity index. Results: When high-dose modulation was required around small organs at risk (OARs), a clinically acceptable IMRT plan was achieved as VMAT usually required longer dose optimisation time. The greatest benefit of VMAT has been rapid treatment delivery allowing improved patient comfort, reduced intra-fraction motion and increased patient throughput. In some papers, 3D-CRT was shown not to meet well the requirements on parotid glands. One paper showed that cerebellum dose was lower for 3D-CRT than IMRT. However, it was found in other papers that OAR sparing with 3D-CRT was reasonable but in complex cases not enough. Conclusions: IMRT usually consists of several treatment fields with different directions, hundreds of beam lets with modulated intensity, an advantage over 3D-CRT, whereas VMAT has advantage over IMRT due to rotating beam utilisation. VMAT has lower total MU and treatment times than IMRT and 3D-CRT, while maintaining similar dosimetric endpoints.

Radiotherapy planning study comparing volumetric modulated arc therapy (VMAT) with intensity modulated radiotherapy (IMRT) in the treatment of bladder and pelvic lymph nodes.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 320-320
Author(s):  
Victoria Harris ◽  
Karole Warren-Oseni ◽  
Robert Anthony Huddart
Keyword(s):  
Low Dose ◽  
Treatment Time ◽  
Statistical Significance ◽  
Volumetric Modulated Arc Therapy ◽  
Radiotherapy Planning ◽  
Rank Test ◽  
Attractive Alternative ◽  
Planning Study ◽  
Significant Difference ◽  
3D Crt

320 Background: VMAT is increasingly used as an alternative to IMRT and has been shown to reduce treatment time and monitor units delivered. We report a radiotherapy (RT) planning study of bladder and pelvic lymph node (LN) RT comparing dosimetric outcomes of VMAT and IMRT techniques. Methods: 8 patients with/at high risk of LN+ bladder cancer were treated with bladder/pelvic LN IMRT. 4 clinical target volumes (CTVs) were defined: Whole bladder (CTV1), Pelvic LN (CTV2), Involved Bladder (CTV3) and Involved LNs (CTV4). Margins were applied to create 4 corresponding PTVs. IMRT plans were compared with VMAT plans in order to assess planning target volume (PTV) and organ at risk (OAR) coverage. The same PTV/OAR volumes and doses were used for each technique. Results: The mean dose statistics were compared for each dosimetric parameter for both techniques. The Wilcoxon signed-rank test was used to compare techniques with statistical significance assumed as p<0.05. Both techniques met prescription goals for PTV coverage. Comparison of conformity indices revealed no significant difference between techniques. VMAT achieved significantly better homogeneity in coverage of PTV2, although this finding was not replicated in the other PTVs (Table). Homogeneity index (HI) was defined as HI = 100x(D2-D98)/ Dp, where Dp = prescribed dose. VMAT resulted in significantly larger volumes of bowel (4.7%) and rectum (4.8%) receiving low dose radiation (15 Gy) than IMRT, although there was no significant difference seen at higher dose levels. Comparison with 3D conformal radiotherapy (3D-CRT) showed that both techniques resulted in a large reduction in bowel irradiation to 45Gy (IMRT = 123cc, VMAT = 145cc and 3D-CRT = 218cc). Conclusions: VMAT offers an attractive alternative to IMRT with similar conformality. Whilst increased low dose RT to OARs was seen with VMAT, it is of doubtful significance relative to the higher doses received by these structures. [Table: see text]

scholarly journals Stereotactic Body Radiotherapy for Small Lung Tumors in the University of Tokyo Hospital

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Hideomi Yamashita ◽  
Wataru Takahashi ◽  
Akihiro Haga ◽  
Satoshi Kida ◽  
Naoya Saotome ◽  
...  
Keyword(s):  
Treatment Time ◽  
Volumetric Modulated Arc Therapy ◽  
Dose Calculation ◽  
Target Volume ◽  
Lung Tumors ◽  
Local Control Rate ◽  
Internal Target Volume ◽  
Eligibility Criteria ◽  
Flattening Filter Free ◽  
Heterogeneity Correction

Our work on stereotactic body radiation therapy (SBRT) for primary and metastatic lung tumors will be described. The eligibility criteria for SBRT, our previous SBRT method, the definition of target volume, heterogeneity correction, the position adjustment using four-dimensional cone-beam computed tomography (4D CBCT) immediately before SBRT, volumetric modulated arc therapy (VMAT) method for SBRT, verifying of tumor position within internal target volume (ITV) using in-treatment 4D-CBCT during VMAT-SBRT, shortening of treatment time using flattening-filter-free (FFF) techniques, delivery of 4D dose calculation for lung-VMAT patients using in-treatment CBCT and LINAC log data with agility multileaf collimator, and SBRT method for centrally located lung tumors in our institution will be shown. In our institution, these efforts have been made with the goal of raising the local control rate and decreasing adverse effects after SBRT.

Dose volume histogram metrics and tumour control probability modelling in locally advanced non-small-cell lung cancer: average intensity dataset versus individual four-dimensional CT phases

2020 ◽  
pp. 1-7
Author(s):  
Cathy Fleming ◽  
Ronan McDermott ◽  
Serena O’Keeffe ◽  
Mary Dunne ◽  
John G. Armstrong ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Locally Advanced ◽  
Target Volume ◽  
Small Cell ◽  
Average Intensity ◽  
Dose Volume Histogram ◽  
Small Cell Lung ◽  
Tumour Control ◽  
Dose Volume

Abstract Aim: This work compares dose-volume constraints (DVCs) and tumour control predictions based on the average intensity projection (AVIP) to those on each phase of the four-dimensional computed tomography. Materials and methods: In this prospective study plans generated on an AVIP for nine patients with locally advanced non-small-cell lung cancer were recalculated on each phase. Dose-volume histogram (DVH) metrics extracted and tumour control probabilities (TCP) were calculated. These were evaluated by Bland–Altman analysis and Pearson Correlation. Results: The largest difference between clinical target volume (CTV) on the individual phases and the internal CTV (iCTV) on the AVIP was seen for the smallest volume. For the planning target volume, the mean of each metric across all phases is well represented by the AVIP value. For most patients, TCPs from individual phases are representative of that on the AVIP. Organ at risk metrics from the AVIP are similar to those seen across all phases. Findings: Utilising traditional DVH metrics on an AVIP is generally valid, however, additional investigation may be required for small target volumes in combination with large motion as the differences between the values on the AVIP and any given phase may be significant.

Dosimetric study of three-dimensional conformal radiotherapy, electronic compensator technique, intensity-modulated radiation therapy and volumetric-modulated arc therapy in whole breast irradiation

2017 ◽  
Vol 16 (4) ◽  
pp. 431-443 ◽  
Author(s):  
Chonnipa Nantavithya ◽  
Kitwadee Saksornchai ◽  
Puntiwa Oonsiri ◽  
Kanjana Shotelersuk
Keyword(s):  
Radiation Therapy ◽  
Volumetric Modulated Arc Therapy ◽  
Three Dimensional ◽  
Intensity Modulated Radiation Therapy ◽  
Conformal Radiotherapy ◽  
Target Volume ◽  
Whole Breast Irradiation ◽  
Breast Irradiation ◽  
Lung Dose ◽  
3D Crt

AbstractBackgroundWhole breast irradiation is an essential treatment after breast-conserving surgery (BCS). However, there are some adverse effects from inhomogeneity and dose to adjacent normal tissues.ObjectiveAim of this study was to compare dosimetry among standard technique, three-dimensional conformal radiotherapy (3D-CRT), and advanced techniques, electronic compensator (ECOMP), inverse intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT).MethodsWhole breast irradiation treatment plans of patients who had underwent BCS and whole breast irradiation were re-planned with all four techniques. Clinical target volume was contoured according to the Radiation Therapy Oncology Group atlas for breast only in patients who had negative node or ductal carcinoma in situ and breast with chest wall for patients with positive node. Planning target volume was non-uniformly expanded. Dose prescription was 50 Gy in 25 fractions with 6 MV photon energy.ResultsIn total, 25 patients underwent whole breast irradiation with computed tomography simulation from November 2013 to November 2014 were included. Six patients with positive nodes were re-planned for breast with chest wall irradiation and 19 patients with negative nodes were re-planned for breast only irradiation. Primary outcome, radical dose homogeneity index (HI) of 3D-CRT, ECOMP, IMRT and VMAT were 0·865, 0·889, 0·890 and 0·866, respectively. ECOMP and IMRT showed significant higher HI than 3D-CRT (p-value<0·001). Secondary outcome, conformity index (CI) of advanced technique were significantly better than 3D-CRT. Lung V20, mean ipsilateral lung dose (MILD), mean heart dose (MHD), heart V25, heart V30 of advanced techniques were also lower than 3D-CRT. ECOMP had better mean lung dose (MLD), mean contralateral lung dose (MCLD) and mean contralateral breast dose (MCBD) when compared with 3D-CRT. Monitor units of advanced techniques were significantly higher than 3D-CRT.ConclusionsHI of ECOMP and IMRT were significantly higher than 3D-CRT technique. All advanced techniques showed statistically better in CI. Lung V20, MILD, heart V25 and heart V30 of advanced techniques were lower than 3D-CRT. However, only ECOMP showed decreased MLD, MHD, MCLD and MCBD when compared with 3D-CRT.

scholarly journals Assessment of robustness against setup uncertainties using probabilistic scenarios in lung cancer: a comparison of proton with photon therapy

2020 ◽  
Vol 93 (1107) ◽  
pp. 20190584 ◽  
Author(s):  
Suliana Teoh ◽  
Ben George ◽  
Francesca Fiorini ◽  
Katherine A Vallis ◽  
Frank Van den Heuvel
Keyword(s):  
Lung Cancer ◽  
Locally Advanced ◽  
Volumetric Modulated Arc Therapy ◽  
Population Data ◽  
Practical Method ◽  
Target Volume ◽  
Limits Of Agreement ◽  
Setup Errors ◽  
Positive Correlations ◽  
Almost All

Objective: We compared the sensitivity of intensity modulated proton therapy (IMPT) and photon volumetric modulated arc therapy (VMAT) plans to setup uncertainties in locally advanced non-small cell lung cancer (NSCLC) using probabilistic scenarios. Methods: Minimax robust (MM) and planning target volume (PTV) optimised IMPT and VMAT nominal plans were created with physical dose of 70 Gy in 35 fractions in 10 representative patients. Using population data of setup errors, a fractionated treatment course was simulated, summed (Dsum) and compared to the nominal plan. Three treatment-course simulations were done for each plan. Target robustness criteria were: dose deviation of ≤5% to clinical target volume (CTV) D98% and CTV V95% ≥ 99.9%. Voxelwise simulation repeatability was analysed using Bland–Altman plots. Acceptable limits of agreement were 2% of the prescription dose. Results: All Dsum met target robustness criteria. While fraction VMAT and MM-IMPT doses were excellent, simulated fraction doses in PTV-IMPT were suboptimal. Almost all (>99%) of VMAT and MM-IMPT fraction doses met both target robustness criteria. For PTV-IMPT, only 96.9 and 80.3% of fractions met CTVD98% and V95% criteria respectively. Simulation repeatability was excellent (limits of agreement range: 0.41–1.1 Gy) with strong positive correlations. Conclusion: When considering the whole treatment course, setup errors do not influence robustness irrespective of planning techniques used. However, on a fraction level, VMAT and MM-IMPT plans are superior compared to PTV-IMPT plans. Advances in knowledge: Probabilistic analysis provides a fast and practical method for evaluating VMAT and IMPT plan sensitivity against setup uncertainty. VMAT and robust-optimised IMPT plans have comparable sensitivity to setup uncertainties in conventionally fractionated treatment for NSCLC.

Effect of translational couch shifts in volumetric modulated arc therapy (VMAT) plans and predicting its impact on daily dose delivery

2017 ◽  
Vol 17 (2) ◽  
pp. 230-243
Author(s):  
Noufal M. Padannayil ◽  
Kallikuzhiyil K. Abdullah ◽  
Pallimanhayil A. R. Subha ◽  
Sanudev Sadanadan
Keyword(s):  
Volumetric Modulated Arc Therapy ◽  
Target Volume ◽  
Normal Tissue Complication Probability ◽  
Planning System ◽  
Treatment Planning System ◽  
Equivalent Uniform Dose ◽  
Tumour Control ◽  
Matlab Code ◽  
Arc Therapy ◽  
The Impact

AbstractAimTo evaluate the impact of couch translational shifts on dose–volume histogram (DVH) and radiobiological parameters [tumour control probability (TCP), equivalent uniform dose (EUD) and normal tissue complication probability (NTCP)] of volumetric modulated arc therapy (VMAT) plans and to develop a simple and swift method to predict the same online, on a daily basis.MethodsIn total, ten prostate patients treated with VMAT technology were selected for this study. The plans were generated using Eclipse TPS and delivered using Clinac ix LINAC equipped with a Millennium 120 multileaf collimator. In order to find the effect of systematic translational couch shifts on the DVH and radiobiological parameters, errors were introduced in the clinically accepted base plan with an increment of 1 mm and up to 5 mm from the iso-centre in both positive and negative directions of each of the three axis, x [right–left (R-L)], y [superior–inferior (S-I)] and z [anterior–posterior (A-P)]. The percentages of difference in these parameters (∆D, ∆TCP, ∆EUD and ∆NTCP) were analyzed between the base plan and the error introduced plans. DVHs of the base plan and the error plans were imported into the MATLAB software (R2013a) and an in-house MATLAB code was generated to find the best curve fitted polynomial functions for each point on the DVH, there by generating predicted DVH for planning target volume (PTV), clinical target volume (CTV) and organs at risks (OARs). Functions f(x, vj), f(y, vj) and f(z, vj) were found to represent the variation in the dose when there are couch translation shifts in R-L, S-I and A-P directions, respectively. The validation of this method was done by introducing daily couch shifts and comparing the treatment planning system (TPS) generated DVHs and radiobiological parameters with MATLAB code predicted parameters.ResultsIt was noted that the variations in the dose to the CTV, due to both systematic and random shifts, were very small. For CTV and PTV, the maximum variations in both DVH and radiobiological parameters were observed in the S-I direction than in the A-P or R-L directions. ∆V70 Gy and ∆V60 Gy of the bladder varied more due to S-I shift whereas, ∆V40 Gy, ∆EUD and ∆NTCP varied due to A-P shifts. All the parameters in rectum were most affected by the A-P shifts than the shifts in other two directions. The maximum percentage of deviation between the TPS calculated and MATLAB predicted DVHs of plans were calculated for targets and OARs and were found to be less than 0·5%.ConclusionThe variations in the parameters depend upon the direction and magnitude of the shift. The DVH curves generated by the TPS and predicted by the MATLAB showed good correlation.

Dosimetric evaluation of SBRT treatment plans of non-central lung tumours: clinical experience

2020 ◽  
pp. 1-21
Author(s):  
Ernest Osei ◽  
Johnson Darko ◽  
Steph Swanson ◽  
Katrina Fleming ◽  
Ronald Snelgrove ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Early Stage ◽  
Organs At Risk ◽  
Volumetric Modulated Arc Therapy ◽  
Target Volume ◽  
Conformal Radiation Therapy ◽  
Lung Sbrt ◽  
Treatment Plans ◽  
The Mean

Abstract Objectives: Lung cancer is the most commonly diagnosed cancer in Canada and the leading cause of cancer-related mortality in both men and women in North America. Surgery is usually the primary treatment option for early-stage non-small cell lung cancer (NSCLC). However, for patients who may not be suitable candidates for surgery, stereotactic body radiation therapy (SBRT) is an alternative method of treatment. SBRT has proven to be an effective technique for treating NSCLC patients by focally administering high radiation dose to the tumour with acceptable risk of toxicity to surrounding healthy tissues. The goal of this comprehensive retrospective dosimetric study is to compare the dosimetric parameters between three-dimensional conformal radiation therapy (3DCRT) and volumetric-modulated arc therapy (VMAT) lung SBRT treatment plans for two prescription doses. Methods: We retrospectively analysed and compared lung SBRT treatment plans of 263 patients treated with either a 3DCRT non-coplanar or with 2–3 VMAT arcs technique at 48 Gy in 4 fractions (48 Gy/4) or 50 Gy in 5 fractions (50 Gy/5) prescribed to the planning target volume (PTV), typically encompassing the 80% isodose volume. All patients were treated on either a Varian 21EX or TrueBeam linear accelerator using 6-MV or 10-MV photon beams. Results: The mean PTV V95% and V100% for treatment plans at 48 Gy/4 are 99·4 ± 0·6% and 96·0 ± 1·0%, respectively, for 3DCRT and 99·7 ± 0·4% and 96·4 ± 3·4%, respectively, for VMAT. The corresponding mean PTV V95% and V100% at 50 Gy/5 are 99·0 ± 1·4% and 95·5 ± 2·5% for 3DCRT and 99·5 ± 0·8% and 96·1 ± 1·6% for VMAT. The CIRI and HI5/95 for the PTV at 48 Gy/4 are 1·1 ± 0·1 and 1·2 ± 0·0 for 3DCRT and 1·0 ± 0·1 and 1·2 ± 0·0 for VMAT. The corresponding CIRI and HI5/95 at 50 Gy/5 are 1·1 ± 0·1 and 1·3 ± 0·1 for 3DCRT and 1·0 ± 0·1 and 1·2 ± 0·0 for VMAT. The mean R50% and D2cm at 48 Gy/4 are 5·0 ± 0·8 and 61·2 ± 7·0% for 3DCRT and 4·9 ± 0·8 and 57·8 ± 7·9% for VMAT. The corresponding R50% and D2cm at 50 Gy/5 are 4·7 ± 0·5 and 65·5 ± 9·4% for 3DCRT and 4·7 ± 0·7 and 60·0 ± 7·2% for VMAT. Conclusion: The use of 3DCRT or VMAT technique for lung SBRT is an efficient and reliable method for achieving dose conformity, rapid dose fall-off and minimising doses to the organs at risk. The VMAT technique resulted in improved dose conformity, rapid dose fall-off from the PTV compared to 3DCRT, although the magnitude may not be clinically significant.

Sign in / Sign up

Export Citation Format

Share Document