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Intensity-modulated radiotherapy and volumetric-modulated arc therapy have distinct clinical advantages in non-small cell lung cancer treatment

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Abstract

This study was conducted to compare the efficacy of intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) in delivering the planned dosage in the treatment of non-small cell lung cancer (NSCLC). Between September 2013 and March 2014, 125 NSCLC patients were randomly chosen and allocated to the IMRT group (n = 65) and VMAT group (n = 60). We compared multiple parameters such as target dose, organ dosimetry, monitor unit (MU) and time of therapy between IMRT and VMAT groups. The prescribed dose coverage of both planning techniques was 95 % of the planning target volumes (PTVs). PTV 95 % and homogeneous index in IMRT plan were greater than those in VMAT plan (both P < 0.05), while no significant difference in conformity index was observed (P > 0.05). The mean total lung V5 and V10 in VMAT group were markedly higher than those in IMRT group, but the V20, V30, and V40 in VMAT group were significantly lower (all P < 0.05), but no statistically significant difference was observed in V15 and V20 (P > 0.05). Furthermore, the planning spine and esophagus at risk volume showed no statistical significances in both groups (P > 0.05). MU of IMRT plan was about 4.2 % less than that of VMAT plan, which was statistically significant (P < 0.001). Both IMRT and VMAT had significant advantages in the treatment of NSCLC. The IMRT may be better for NSCLC patients with poor pulmonary function, and VMAT may be recommended for NSCLC patients with normal pulmonary function.

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References

  1. Yun F, Jia Y, Li X, Yuan L, Sun Q, Yu H, et al. Clinicopathological significance of PTEN and PI3K/AKT signal transduction pathway in non-small cell lung cancer. Int J Clin Exp Pathol. 2013;6:2112–20.

    PubMed Central  PubMed  Google Scholar 

  2. Liu XH, Liu ZL, Sun M, Liu J, Wang ZX, De W. The long non-coding RNA HOTAIR indicates a poor prognosis and promotes metastasis in non-small cell lung cancer. BMC Cancer. 2013;13:464.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Chen WL, Kuo KT, Chou TY, Chen CL, Wang CH, Wei YH, et al. The role of cytochrome c oxidase subunit Va in non-small cell lung carcinoma cells: association with migration, invasion and prediction of distant metastasis. BMC Cancer. 2012;12:273.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Tran QN. A novel method for finding non-small cell lung cancer diagnosis biomarkers. BMC Med Genomics. 2013;6(Suppl 1):S11.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Langer CJ, Mok T, Postmus PE. Targeted agents in the third-/fourth-line treatment of patients with advanced (stage III/IV) non-small cell lung cancer (NSCLC). Cancer Treat Rev. 2013;39:252–60.

    Article  CAS  PubMed  Google Scholar 

  6. Zhu N, Gong Y, He J, Xia J, Chen X. Influence of methylenetetrahydrofolate reductase C677T polymorphism on the risk of lung cancer and the clinical response to platinum-based chemotherapy for advanced non-small cell lung cancer: an updated meta-analysis. Yonsei Med J. 2013;54:1384–93.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Chang A. Chemotherapy, chemoresistance and the changing treatment landscape for NSCLC. Lung Cancer. 2011;71:3–10.

    Article  PubMed  Google Scholar 

  8. Wiezorek T, Brachwitz T, Georg D, Blank E, Fotina I, Habl G, et al. Rotational IMRT techniques compared to fixed gantry IMRT and tomotherapy: multi-institutional planning study for head-and-neck cases. Radiat Oncol. 2011;6:20.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Lin H, Huang S, Deng X, Zhu J, Chen L. Comparison of 3D anatomical dose verification and 2D phantom dose verification of IMRT/VMAT treatments for nasopharyngeal carcinoma. Radiat Oncol. 2014;9:71.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Werbrouck J, De Ruyck K, Duprez F, Veldeman L, Claes K, Van Eijkeren M, et al. Acute normal tissue reactions in head-and-neck cancer patients treated with IMRT: influence of dose and association with genetic polymorphisms in DNA DSB repair genes. Int J Radiat Oncol Biol Phys. 2009;73:1187–95.

    Article  CAS  PubMed  Google Scholar 

  11. Ning ZH, Mu JM, Jin JX, Li XD, Li QL, Gu WD, et al. Single arc volumetric-modulated arc therapy is sufficient for nasopharyngeal carcinoma: a dosimetric comparison with dual arc VMAT and dynamic MLC and step-and-shoot intensity-modulated radiotherapy. Radiat Oncol. 2013;8:237.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Onal C, Arslan G, Parlak C, Sonmez S. Comparison of IMRT and VMAT plans with different energy levels using Monte-Carlo algorithm for prostate cancer. Jpn J Radiol. 2014;32:224–32.

    Article  PubMed  Google Scholar 

  13. Peters S, Schiefer H, Plasswilm L. A treatment planning study comparing Elekta VMAT and fixed field IMRT using the varian treatment planning system eclipse. Radiat Oncol. 2014;9:153.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Zhuang M, Zhang T, Chen Z, Lin Z, Li D, Peng X, et al. Advanced nasopharyngeal carcinoma radiotherapy with volumetric modulated arcs and the potential role of flattening filter-free beams. Radiat Oncol. 2013;8:120.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Gong G, Wang R, Guo Y, Zhai D, Liu T, Lu J, et al. Reduced lung dose during radiotherapy for thoracic esophageal carcinoma: VMAT combined with active breathing control for moderate DIBH. Radiat Oncol. 2013;8:291.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Lu SH, Cheng JC, Kuo SH, Lee JJ, Chen LH, Wu JK, et al. Volumetric modulated arc therapy for nasopharyngeal carcinoma: a dosimetric comparison with TomoTherapy and step-and-shoot IMRT. Radiother Oncol. 2012;104:324–30.

    Article  PubMed  Google Scholar 

  17. Theunissen EA, Zuur CL, Yurda M, van der Baan S, Kornman AF, de Boer J, et al. Cochlea sparing effects of intensity modulated radiation therapy in head and neck cancers patients: a long-term follow-up study. J Otolaryngol Head Neck Surg. 2014;43:30.

    Article  PubMed  Google Scholar 

  18. Hakariya T, Obata S, Igawa T, Sakai H. Feasibility of simultaneous integrated boost IMRT (SIB-IMRT) for castration-resistant prostate cancer. Anticancer Res. 2014;34:4261–5.

    PubMed  Google Scholar 

  19. Zhou X, Ou X, Xu T, Wang X, Shen C, Ding J, et al. Effect of dosimetric factors on occurrence and volume of temporal lobe necrosis following intensity modulated radiation therapy for nasopharyngeal carcinoma: a case-control study. Int J Radiat Oncol Biol Phys. 2014;90:261–9.

    Article  PubMed  Google Scholar 

  20. Kim ES, Yeo SG. Volumetric modulated arc radiotherapy sparing the thyroid gland for early-stage glottic cancer: a dosimetrical analysis. Oncol Lett. 2014;7:1987–91.

    PubMed Central  PubMed  Google Scholar 

  21. Ma P, Wang X, Xu Y, Dai J, Wang L. Applying the technique of volume-modulated arc radiotherapy to upper esophageal carcinoma. J Appl Clin Med Phys. 2014;15:4732.

    PubMed  Google Scholar 

  22. Xiao L, Huang R, You K, Chang H, Qiu B, Xiao W, et al. Feasibility study on Xelox (capecitabine plus oxapliplatin) in the volumetric modulated arc therapy (VMAT)-based preoperative chemoradiotherapy for locally advanced rectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi. 2014;17:219–24.

    PubMed  Google Scholar 

  23. Treutwein M, Hipp M, Koelbl O, Dobler B. Searching standard parameters for volumetric modulated arc therapy (VMAT) of prostate cancer. Radiat Oncol. 2012;7:108.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Holt A, van Vliet-Vroegindeweij C, Mans A, Belderbos JS, Damen EM. Volumetric-modulated arc therapy for stereotactic body radiotherapy of lung tumors: a comparison with intensity-modulated radiotherapy techniques. Int J Radiat Oncol Biol Phys. 2011;81:1560–7.

    Article  PubMed  Google Scholar 

  25. Jiang X, Li T, Liu Y, Zhou L, Xu Y, Zhou X, et al. Planning analysis for locally advanced lung cancer: dosimetric and efficiency comparisons between intensity-modulated radiotherapy (IMRT), single-arc/partial-arc volumetric modulated arc therapy (SA/PA-VMAT). Radiat Oncol. 2011;6:140.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Paci M, Sgarbi G, Ferrari G, De Franco S, Annessi V. Controversies over UICC-TNM classification of non-small cell lung cancer: model for a diagnostic path. Chest. 2002;122:754.

    Article  PubMed  Google Scholar 

  27. Kim MJ, Yeo SG, Kim ES, Min CK, Se An P. Intensity-modulated stereotactic body radiotherapy for stage I non-small cell lung cancer. Oncol Lett. 2013;5:840–4.

    PubMed Central  CAS  PubMed  Google Scholar 

  28. Abo-Madyan Y, Aziz MH, Aly MM, Schneider F, Sperk E, Clausen S, et al. Second cancer risk after 3D-CRT, IMRT and VMAT for breast cancer. Radiother Oncol. 2014;110:471–6.

    Article  PubMed  Google Scholar 

  29. Chan OS, Lee MC, Hung AW, Chang AT, Yeung RM, Lee AW. The superiority of hybrid-volumetric arc therapy (VMAT) technique over double arcs VMAT and 3D-conformal technique in the treatment of locally advanced non-small cell lung cancer—a planning study. Radiother Oncol. 2011;101:298–302.

    Article  PubMed  Google Scholar 

  30. Wolff D, Stieler F, Welzel G, Lorenz F, Abo-Madyan Y, Mai S, et al. Volumetric modulated arc therapy (VMAT) vs. serial tomotherapy, step-and-shoot IMRT and 3D-conformal RT for treatment of prostate cancer. Radiother Oncol. 2009;93:226–33.

    Article  PubMed  Google Scholar 

  31. Merrow CE, Wang IZ, Podgorsak MB. A dosimetric evaluation of VMAT for the treatment of non-small cell lung cancer. J Appl Clin Med Phys. 2013;14:4110.

    Google Scholar 

  32. Agapito J. On the possible benefits of a hybrid VMAT technique in the treatment of non-small cell lung cancer. Med Dosim. 2013;38:460–6.

    Article  PubMed  Google Scholar 

  33. Bertelsen A, Hansen O, Brink C. Does VMAT for treatment of NSCLC patients increase the risk of pneumonitis compared to IMRT?—a planning study. Acta Oncol. 2012;51:752–8.

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to acknowledge the reviewers for their helpful comments on this paper.

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The authors have declared that no competing interests exist.

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Correspondence to Jun Zhang.

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Zhang, J., Yu, XL., Zheng, GF. et al. Intensity-modulated radiotherapy and volumetric-modulated arc therapy have distinct clinical advantages in non-small cell lung cancer treatment. Med Oncol 32, 94 (2015). https://doi.org/10.1007/s12032-015-0546-6

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