Treatment planning and dosimetric comparison study on two different volumetric modulated arc therapy delivery techniques

Abstract

Aim

To compare and evaluate the performance of two different volumetric modulated arc therapy delivery techniques.

Background

Volumetric modulated arc therapy is a novel technique that has recently been made available for clinical use. Planning and dosimetric comparison study was done for Elekta VMAT and Varian RapidArc for different treatment sites.

Materials and methods

Ten patients were selected for the planning comparison study. This includes 2 head and neck, 2 oesophagus, 1 bladder, 3 cervix and 2 rectum cases. Total dose of 50[[ce:hsp sp="0.25"/]]Gy was given for all the plans. All plans were done for RapidArc using Eclipse and for Elekta VMAT with Monaco treatment planning system. All plans were generated with 6[[ce:hsp sp="0.25"/]]MV X-rays for both RapidArc and Elekta VMAT. Plans were evaluated based on the ability to meet the dose volume histogram, dose homogeneity index, radiation conformity index, estimated radiation delivery time, integral dose and monitor units needed to deliver the prescribed dose.

Results

RapidArc plans achieved the best conformity (CI_95%[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]1.08[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.07) while Elekta VMAT plans were slightly inferior (CI_95%[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]1.10[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.05). The in-homogeneity in the PTV was highest with Elekta VMAT with HI equal to 0.12[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.02[[ce:hsp sp="0.25"/]]Gy when compared to RapidArc with 0.08[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.03. Significant changes were observed between the RapidArc and Elekta VMAT plans in terms of the healthy tissue mean dose and integral dose. Elekta VMAT plans show a reduction in the healthy tissue mean dose (6.92[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]2.90)[[ce:hsp sp="0.25"/]]Gy when compared to RapidArc (7.83[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]3.31)[[ce:hsp sp="0.25"/]]Gy. The integral dose is found to be inferior with Elekta VMAT (11.50[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]6.49)[[ce:hsp sp="0.25"/]]×[[ce:hsp sp="0.25"/]]10⁴[[ce:hsp sp="0.25"/]]Gy[[ce:hsp sp="0.25"/]]cm³ when compared to RapidArc (13.11[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]7.52)[[ce:hsp sp="0.25"/]]×[[ce:hsp sp="0.25"/]]10⁴[[ce:hsp sp="0.25"/]]Gy[[ce:hsp sp="0.25"/]]cm³. Both Varian RapidArc and Elekta VMAT respected the planning objective for all organs at risk. Gamma analysis result for the pre-treatment quality assurance shows good agreement between the planned and delivered fluence for 3[[ce:hsp sp="0.25"/]]mm DTA, 3% DD for all the evaluated points inside the PTV, for both VMAT and RapidArc techniques.

Conclusion

The study concludes that a variable gantry speed with variable dose rate is important for efficient arc therapy delivery. RapidArc presents a slight improvement in the OAR sparing with better target coverage when compared to Elekta VMAT. Trivial differences were noted in all the plans for organ at risk but the two techniques provided satisfactory conformal avoidance and conformation.