Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Clin Oncol. Apr 10, 2012; 3(4): 57-62
Published online Apr 10, 2012. doi: 10.5306/wjco.v3.i4.57
A prospective trial of volumetric intensity-modulated arc therapy vs conventional intensity modulated radiation therapy in advanced head and neck cancer
Simon D Fung-Kee-Fung, Rachel Hackett, Lee Hales, Graham Warren, Anurag K Singh
Simon D Fung-Kee-Fung, Rachel Hackett, Lee Hales, Graham Warren, Anurag K Singh, Department of Radiation Medicine, Roswell Park Cancer Institute, University at Buffalo School of Medicine, Elm and Carlton Streets, Buffalo, NY 14214, United States
Author contributions: All authors contributed equally to the manuscript.
Correspondence to: Anurag K Singh, MD, Associate Professor, Director of Radiation Medicine Residency Program, Department of Radiation Medicine, Roswell Park Cancer Institute, University at Buffalo School of Medicine, Elm and Carlton Streets, Buffalo, NY 14263, United States. simon.fung-kee-fung@roswellpark.org
Telephone: +1-716-845-5715 Fax: +1-716-845-7616
Received: September 26, 2011
Revised: February 15, 2012
Accepted: April 1, 2012
Published online: April 10, 2012
Abstract

AIM: To prospectively compare volumetric intensity-modulated arc therapy (VMAT) and conventional intensity-modulated radiation therapy (IMRT) in coverage of planning target volumes and avoidance of multiple organs at risk (OARs) in patients undergoing definitive chemoradiotherapy for advanced (stage III or IV) squamous cell cancer of the head and neck.

METHODS: Computed tomography scans of 20 patients with advanced tumors of the larynx, naso-, oro- and hypopharynx were prospectively planned using IMRT (7 field) and VMAT using two arcs. Calculated doses to planning target volume (PTV) and OAR were compared between IMRT and VMAT plans. Dose-volume histograms (DVH) were utilized to obtain calculated doses to PTV and OAR, including parotids, cochlea, spinal cord, brainstem, anterior tongue, pituitary and brachial plexus. DVH’s for all structures were compared between IMRT and VMAT plans. In addition the plans were compared for dose conformity and homogeneity. The final treatment plan was chosen by the treating radiation oncologist.

RESULTS: VMAT was chosen as the ultimate plan in 18 of 20 patients (90%) because the plans were thought to be otherwise clinically equivalent. The IMRT plan was chosen in 2 of 20 patients because the VMAT plan produced concentric irradiation of the cord which was not overcome even with an avoidance structure. For all patients, VMAT plans had a lower number of average monitor units on average (MU = 542.85) than IMRT plans (MU = 1612.58) (P < 0.001). Using the conformity index (CI), defined as the 95% isodose volume divided by the PTV, the IMRT plan was more conformal with a lower conformity index (CI = 1.61) than the VMAT plan (CI = 2.00) (P = 0.003). Dose homogeneity, as measured by average standard deviation of dose distribution over the PTV, was not different with VMAT (1.45 Gy) or IMRT (1.73 Gy) (P = 0.069). There were no differences in sparing organs at risk.

CONCLUSION: In this prospective study, VMAT plans were chosen over IMRT 90% of the time. Compared to IMRT, VMAT plans used only one third of the MUs, had shorter treatment times, and similar sparing of OAR. Overall, VMAT provided similar dose homogeneity but less conformity in PTV irradiation compared to IMRT. This difference in conformity was not clinically significant.

Keywords: Volumetric intensity-modulated arc therapy; Intensity-modulated radiation therapy; Target coverage; Organs at risk