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Coplanar VMAT vs. noncoplanar VMAT in the treatment of sinonasal cancer

Koplanare VMAT vs. nichtkoplanare VMAT bei der Behandlung des sinunasalen Krebses

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Abstract

Background

Previous studies showed that noncoplanar intensity-modulated radiotherapy (NC-IMRT) for sinonasal cancer is superior to coplanar intensity-modulated radiotherapy (IMRT). Volumetric-modulated arc therapy (VMAT) is a newly introduced treatment modality, and the performance of noncoplanar VMAT for sinonasal cancer has not been well described to date.

Purpose

To compare the dosimetry difference of noncoplanar VMAT (NC-VMAT), coplanar VMAT (co-VMAT), and NC-IMRT for sinonasal cancer.

Patients and methods

Ten postoperative patients with sinonasal cancer were randomly selected for planning with NC-VMAT, co-VMAT, and NC-IMRT. Two planning target volumes (PTVs) were contoured representing high-risk and low-risk regions set to receive a median absorbed dose (D50 %) of 68 Gy and 59 Gy, respectively. The homogeneity index (HI), conformity index (CI), dose-volume histograms (DVHs), and delivery efficiency were all evaluated.

Results

Both NC-VMAT and co-VMAT showed superior dose homogeneity and conformity in PTVs compared with NC-IMRT. There was no significant difference between NC-VMAT and co-VMAT in PTV coverage. Both VMAT plans provided a better protection for organs at risk (OARs) than NC-IMRT plans, and NC-VMAT showed a small improvement over co-VMAT in sparing of OARs. For peripheral doses, the doses to breast, thyroid, and larynx in the NC-IMRT plans were significantly higher than those in both VMAT plans. Compared to NC-VMAT, co-VMAT significantly reduced peripheral doses. NC-VMAT and co-VMAT reduced the average delivery time by 63.2 and 64.2 %, respectively, in comparison with NC-IMRT. No differences in delivery efficiency were observed between the two VMAT plans.

Conclusion

Compared to NC-VMAT, co-VMAT showed similar PTV coverage and comparable OAR sparing but significantly reduced peripheral doses and positioning uncertainty. We propose to give priority to coplanar VMAT in the treatment of sinonasal cancer.

Zusammenfassung

Hintergrund

Frühere Studien zeigten, dass die nichtkoplanare intensive modulierte Radiotherapie (NC-IMRT) für den sinunasalen Krebs der koplanaren intensiven modulierten Radiotherapie (IMRT) überlegen ist. Kürzlich wurde die volumetrische modulierte Lichtbogentherapie als neue Behandlungsmethode eingeführt Außerdem wurde die Leistung der nichtkoplanaren VMAT für den sinunasalen Krebs noch nicht gut beschrieben.

Ziel

Ziel der Studie war es, die Dosimetriedifferenz von nichtkoplanarer VMAT (NC-VMAT), koplanarer VMAT (co-VMAT) und NC-IMRT für sinunasalen Krebs zu vergleichen.

Material und Methoden

Zehn postoperative Patienten mit sinunasalem Krebs wurden zufällig ausgewählt und mit NC-VMAT, co-VMAT und NC-IMRT behandelt. Zwei Planungszielvolumen (PTVs), die hohen und niedrigen Risikoregionen entsprechen, wurden konturiert, um eine mittlere aufgenommene Dosis (D50 %) von 68 Gy und 59 Gy zu erhalten. Der Homogenitätsindex (HI) und der Konformitätsindex (CI), Dosis-Volumen-Histogramme (DVHs) sowie die Ausgangseffizienz wurden bewertet.

Ergebnisse

Im Vergleich mit NC-IMRT zeigten sowohl NC-VMAT als auch co-VMAT überlegene Dosishomogenität und Dosiskonformität bei den PTVs. Es gab keine offensichtliche Differenz zwischen NC-VMAT und co-VMAT in Bezug auf die Erfassung der PTVs. Beide VMAT-Pläne boten den Organen einen besseren Schutz vor Risiken (OARs) als NC-IMRT-Pläne. Übrigens zeigte NC-VMAT eine kleine Verbesserung für OARs im Vergleich mit co-VMAT. Die peripheren Dosen, die Dosis auf Brust, Schilddrüse und Kehlkopf, waren in den NC-IMRT-Plänen deutlich höher als in den beiden VMAT-Plänen. Im Vergleich zu NC-VMAT reduzierte co-VMAT deutlich die peripheren Dosen. NC-VMAT und co-VMAT reduzierten die durchschnittliche Ausgangszeit um 63,2% und 64,2 % im Vergleich zu NC-IMRT. Keine Unterschiede wurden zwischen beiden VMAT-Plänen hinsichtlich der Ausgangseffizienz beobachtet.

Schlussfolgerung

Im Vergleich zu NC-VMAT zeigte co-VMAT ähnliche PTVs-Erfassung und vergleichbare OARs, aber deutlich reduzierte periphere Dosen und eine Positionierungsunsicherheit. Wir schlagen vor, bei der Behandlung für sinunasalen Krebs der co-VMAT den Vorzug zu geben.

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Acknowledgments

The authors thank Jianxue Jin and his colleagues from Elekta China Co Ltd. for advice and guidance. This research was supported by the Sanitation Bureau Guidance Project of Changzhou (WZ201303) and National Natural Science Foundation of China(81301960).

Conflict of interest

N. Zhong-Hua, J. Jing-Ting, L. Xiao-Dong, M. Jin-Ming, M. Jun-Chong, J. Jian-Xue, G. Ming, L. Qi-Lin, G. Wen-Dong, C. Lu-Jun, and P. Hong-Lei state that there are no conflicts of interest

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Authors and Affiliations

  1. Department of Radiation Oncology, The Third Affiliated Hospital, Soochow University, 185 Juqian Road, 213003, Changzhou, China

    Ning Zhong-Hua M.D., Mu Jin-Ming M.D., Mo Jun-Chong PH.D., Gao Ming PH.D., Li Qi-Lin M.D., Gu Wen-Dong M.D. & Pei Hong-Lei M.D.

  2. Department of Tumor Biological Treatment, The Third Affiliated Hospital, Soochow University, Changzhou, China

    Jiang Jing-Ting M.D., Li Xiao-Dong M.D. & Chen Lu-Jun M.D.

  3. Department of Radiation Physics, Elekta China Co. Ltd, 27 North Fourth Ring, Mid Road, 100101, Beijing, Chaoyang District, China

    Jin Jian-Xue PH.D.

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  1. Ning Zhong-Hua M.D.
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Correspondence to Pei Hong-Lei M.D..

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Zhong-Hua, N., Jing-Ting, J., Xiao-Dong, L. et al. Coplanar VMAT vs. noncoplanar VMAT in the treatment of sinonasal cancer. Strahlenther Onkol 191, 34–42 (2015). https://doi.org/10.1007/s00066-014-0760-8

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  • DOI: https://doi.org/10.1007/s00066-014-0760-8

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