Volumetric-modulated arc therapy vs c-IMRT in esophageal cancer: A treatment planning comparison

doi:10.3748/wjg.v18.i37.5266

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 18, Issue 37

This Article

Citation of this article

Corresponding Author of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (5004)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-2) series, Tables (1-5) series.

Item

Count

PDF

589

HTML

3796

Figures (1-2)

382

Tables (1-5)

237

Sum=5004

Oct 7, 2012 (publication date) through Mar 6, 2025

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Gastroenterology

ISSN

1007-9327

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Brief Article

World J Gastroenterol. Oct 7, 2012; 18(37): 5266-5275
Published online Oct 7, 2012. doi: 10.3748/wjg.v18.i37.5266

Table 1 Characteristics of patients (n = 20)

Variables	n
Gender
Male	16
Female	4
Age range (yr)	45-82
Stage¹
II	5
III	10
IV	5
Histology
Squamous carcinoma	18
Adenocarcinoma	2

¹According to the American Joint Committee on Cancer 2006 Guidelines.

Table 2 Parameters used in normal tissue complication probability

Organ	Size factor (n)	Slope (m)	TD5/5 (Gy)	TD50/5 (Gy)	End point
Lung	0.87	0.18	17.5	24.5	Pneumonitis
Heart	0.35	0.10	40	48	Pericarditis
Spinal cord	0.05	0.175	47	66.5	Myelitis/necrosis

TD5/5: Tolerance dose leading to 5% complication rates at 5 years; TD50/5: Tolerance dose leading to 50% complication rates at 5 years.

Table 3 Dosimetric results for planning target volume and monitor units

Variable	IMRT-5F	IMRT-7F	IMRT-9F	VMAT-1A	VMAT-2A	P < 0.05
D_mean
Cervical	63.68 ± 0.37	63.07 ± 0.36	62.55 ± 0.39	63.97 ± 0.08	63.63 ± 0.49	2A vs 7F and 9F
Upper	63.30 ± 0.66	62.74 ± 0.49	62.38 ± 0.34	63.90 ± 0.45	63.43 ± 0.63	1A, 2A vs 7F and 9F
Middle	64.12 ± 1.03	64.05 ± 1.27	63.88 ± 1.27	64.83 ± 1.06	64.21 ± 0.59	1A vs 5F and 9F
Lower	63.14 ± 0.90	63.20 ± 1.09	62.98 ± 0.87	64.17 ± 1.26	63.98 ± 1.36	1A vs 5F, 7F and 9F
HI
Cervical	1.10 ± 0.01	1.09 ± 0.01	1.07 ± 0.01	1.11 ± 0.00	1.10 ± 0.01	1A, 2A vs 7F and 9F
Upper	1.09 ± 0.02	1.08 ± 0.01	1.07 ± 0.01	1.10 ± 0.01	1.09 ± 0.02	1A vs 7F and 9F; 2A vs 9F
Middle	1.11 ± 0.02	1.11 ± 0.03	1.11 ± 0.03	1.12 ± 0.02	1.11 ± 0.01	1A vs 9F
Lower	1.09 ± 0.02	1.09 ± 0.03	1.09 ± 0.02	1.11 ± 0.04	1.11 ± 0.03	1A vs 9F
CI
Cervical	0.63 ± 0.03	0.66 ± 0.02	0.74 ± 0.04	0.78 ± 0.03	0.80 ± 0.03	2A vs 5F, 7F, 9F and 1A
Upper	0.62 ± 0.04	0.66 ± 0.03	0.73 ± 0.02	0.79 ± 0.03	0.80 ± 0.02	1A, 2A vs 5F, 7F and 9F
Middle	0.62 ± 0.09	0.67 ± 0.08	0.71 ± 0.10	0.76 ± 0.05	0.74 ± 0.08	1A, 2A vs 5F and 7F
Lower	0.64 ± 0.05	0.67 ± 0.05	0.71 ± 0.05	0.76 ± 0.05	0.77 ± 0.04	1A, 2A vs 5F and 7F
MU
Cervical	1088 (921-1157)	1261 (1094-1393)	1236 (1004-1413)	610 (546 -665)	525 (452-590)	2A vs 5F, 7F, 9F and 1A
Upper	1110 (841-1244)	1251 (950-1377)	1334 (1040-1592)	679 (538-825)	682 (475-1004)	1A, 2A vs 5F, 7F and 9F
Middle	831 (707-980)	903 (808-1086)	999 (858-1219)	418 (347-459)	431 (376-503)	1A, 2A vs 5F, 7F and 9F
Lower	826 (721-966)	923 (720-1234)	1086 (958-1375)	440 (387-540)	419 (347-531)	1A , 2A vs 5F, 7F and 9F

IMRT: Intensity modulated radiotherapy; VMAT: Volumetric modulated arc therapy; F: Coplanar field; A: Arc; HI: Homogeneity index; CI: Conformity index; D_mean: Mean dose; MU: Monitor units.

Table 4 Dosimetric comparison for organs at risk of conventional sliding window intensity-modulated radiotherapy and volumetric-modulated arc therapy in cervical and upper thoracic esophageal cancer, and in middle and lower thoracic esophageal cancer, mean value (range)

Organ	Variable	c-IMRT (5F, 7F, 9F)	VMAT (1A, 2A)	Relative reduction (%)	P < 0.05
In cervical and upper thoracic
Lung (Gy)	MLD¹	12.65 (12.38-13.04)	12.57 (12.35-12.79)	0.6	2A vs 7F, 9F; 1A vs 7F
	MLD²	14.35 (13.91-14.76)	13.94 (13.74-14.14)	2.9	2A vs 7F, 9F
	V5¹	48.52 (46.28-50.52)	51.20 (51.03-51.37)	-5.5	1A, 2A vs 5F, 7F
	V5²	61.53 (57.51-65.06)	66.25 (66.07-66.43)	-7.7	1A , 2A vs 5F, 7F
	V10¹	39.30 (37.41-41.58)	43.44 (43.23-43.65)	-10.5	1A , 2A vs 5F, 7F; 2A vs 9F
	V10²	48.17 (44.18-52.07)	54.25 (53.70-54.79)	-12.6	1A , 2A vs 5F, 7F, 9F
	V20¹	24.70 (23.93-25.16)	24.17 (23.08-25.26)	2.1	1A vs 5F
	V20²	25.58 (24.29-26.23)	22.85 (21.94-23.76)	10.7	NS
	V30¹	14.96 (14.42-15.33)	12.99 (12.99-12.99)	13.2	1A, 2A vs 5F, 7F, 9F
	V30²	14.52 (14.27-15.00)	12.01 (11.58-12.04)	17.3	1A, 2A vs 5F, 7F; 2A vs 9F
Heart (%)	V30¹	6.83 (5.7-7.41)	5.30 (4.57-5.62)	22.4	NS
	V30²	15.20 (13.62-16.96)	10.11 (9.98-10.24)	33.5	1A vs 7F, 9F, 2A
	V40¹	4.33 (3.55-5.08)	2.68 (2.45-2.91)	38.1	NS
	V40²	8.32 (7.00-10.33)	5.30 (5.08-5.22)	36	1A vs 5F, 7F, 9F; 2A vs 5F
	V50¹	2.62 (2.07-3.09)	1.44 (1.43-1.45)	45	NS
	V50²	4.33 (3.44-5.53)	2.63 (2.59-2.67)	39.3	NS
Spinal cord (Gy)	D_max¹	37.92 (37.53-38.32)	37.74 (37.31-38.17)	0.5	NS
	D_max²	37.85 (37.41-38.43)	38.41 (38.05-38.76)	-1.5	NS
Head of humerus	D_max¹	10.00 (5.97-17.59)	21.88 (20.80-22.95)	-118.8	1A , 2A vs 5F, 7F, 9F
(Gy)	D_max²	7.57 (6.47-9.61)	26.44 (26.35-26.52)	-249.3	1A , 2A vs 5F, 7F
	D_mean¹	3.24 (2.07-4.71)	12.27 (11.85-12.69)	-278.7	2A vs 5F, 7F, 9F, 1A
	D_mean²	2.89 (1.47-4.86)	15.26 (14.61-15.90)	-428	2A vs 5F, 7F, 9F, 1A
In middle and lower thoracic
Lung (Gy)	MLD³	15.03 (14.86-15.27)	15.38 (15.24-15.51)	-2.3	1A, 2A vs 5F, 7F
	MLD⁴	15.37 (15.01-15.81)	15.67 (15.51-15.82)	-2	1A vs 5F
	V5³	74.86 (71.00-79.05)	82.83 (82.72-82.93)	-10.6	1A, 2A vs 5F, 7F, 9F
	V5⁴	79.36 (72.43-85.85)	89.91 (89.77-90.04)	-13.3	1A, 2A vs 5F, 7F, 9F
	V10³	55.14 (52.64-58.66)	65.26 (64.75-65.76)	-18.4	1A, 2A vs 5F, 7F, 9F
	V10⁴	59.56 (54.27-64.76)	72.54 (72.04-73.03)	-21.8	1A, 2A vs 5F, 7F; 2A vs 9F
	V20³	24.39 (23.84-24.96)	23.05 (22.28-23.81)	5.5	2A vs 7F, 9F, 1A
	V20⁴	25.32 (24.48-26.66)	21.40 (20.69-22.11)	15.5	1A, 2A vs 5F
	V30³	12.64 (12.08-13.01)	10.97 (10.88-11.06)	13.2	1A,2A vs 5F, 7F; 2A vs 9F
	V30⁴	11.13 (10.55-12.20)	9.10 (8.58-9.62)	18.2	1A, 2A vs 5F, 7F; 2A vs 9F
Heart (%)	V30³	47.30 (46.61-48.20)	42.26 (40.72-43.79)	10.7	1A vs 5F, 7F, 9F
	V30⁴	72.16 (67.81-78.60)	56.55 (55.52-57.57)	21.6	1A vs 5F, 7F, 9F; 2A vs 5F
	V40³	26.89 (24.86-28.14)	22.84 (20.98-24.69)	15.1	1A vs 7F
	V40⁴	33.53 (30.63-38.19)	26.27 (26.21-26.32)	21.7	2A vs 5F
	V50³	14.06 (12.50-16.06)	9.89 (8.93-10.85)	29.7	1A vs 5F, 7F, 9F
	V50⁴	17.99 (14.48-22.87)	11.16 (10.93-11.39)	38	1A, 2A vs 5F; 2A vs 7F, 9F
Spinal cord (Gy)	D_max³	39.03 (38.91-39.15)	38.70 (38.54-38.86)	0.8	NS
	D_max⁴	37.61 (37.45-37.91)	37.99 (37.78-38.20)	-1	NS

Wilcoxon’s signed ranks test.

¹Cervical thoracic esophageal cancer;

²upper thoracic esophageal cancer;

³middle thoracic esophageal cancer;

⁴lower thoracic esophageal cancer. c-IMRT: Conventional sliding window intensity-modulated radiotherapy; VMAT: Volumetric-modulated arc therapy; MLD: Mean dose of lungs; D_max: Maximal dose; D_mean: Mean dose; F: Coplanar field; A: Arc; V_X: The percentage of organ receiving a dose > X Gy; NS: Not significant.

Table 5 Normal tissue complication probability results for organs at risk

Organ	IMRT-5F	IMRT-7F	IMRT-9F	VMAT-1A	VMAT-2A	P < 0.05
Lung
Cervical	0.24 ± 0.14	0.24 ± 0.15	0.32 ± 0.22	0.22 ± 0.18	0.13 ± 0.09	1A vs 9F; 2A vs 5F, 7F, 9F
Upper	0.73 ± 0.62	0.77 ± 0.66	0.84 ± 0.71	0.41 ± 0.37	0.30 ± 0.23	1A vs 7F, 9F; 2A vs 5F, 7F, 9F
Middle	0.62 ± 0.48	0.59 ± 0.48	0.60 ± 0.47	0.57 ± 0.45	0.50 ± 0.41	2A vs 5F
Lower	0.59 ± 0.45	0.59 ± 0.50	0.67 ± 0.46	0.57 ± 0.54	0.46 ± 0.37	2A vs 5F
Heart
Cervical	0	0	0	0	0	NS
Upper	0.02 (0-0.12)	0.02 (0-0.09)	0 (0-0.02)	0	0	NS
Middle	0.61 (0.05-1.07)	0.94 (0.01-4.24)	0.31 (0.01-1.17)	0.13 (0-0.58)	0.21 (0-0.80)	1A vs 5F, 7F, 9F
Lower	6.66 (1.14-16.04)	1.97 (0.11-5.09)	1.76 (0.07-5.95)	1.32 (0-5.81)	0.66 (0-1.59)	1A vs 5F, 9F; 2A vs 5F, 7F, 9F
Spinal cord
Cervical	0	0	0	0	0	NS
Upper	0	0	0	0	0	NS
Middle	0.002 (0-0.01)	0.006 (0-0.03)	0.008 (0-0.04)	0	0	NS
Lower	0	0	0	0	0	NS

IMRT: Intensity-modulated radiotherapy; VMAT: Volumetric modulated arc therapy; F: Coplanar field; A: Arc; NS: Not significant.

Citation: Yin L, Wu H, Gong J, Geng JH, Jiang F, Shi AH, Yu R, Li YH, Han SK, Xu B, Zhu GY. Volumetric-modulated arc therapy vs c-IMRT in esophageal cancer: A treatment planning comparison. World J Gastroenterol 2012; 18(37): 5266-5275
URL: https://www.wjgnet.com/1007-9327/full/v18/i37/5266.htm
DOI: https://dx.doi.org/10.3748/wjg.v18.i37.5266