Vol 26, No 6 (2021)
Research paper
Published online: 2021-11-05

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Analysis of the planned, delivered dose distributions and quality assurance for helical tomotherapy and volumetric modulated arc therapy in locally advanced non-small cell lung cancer

Pitchayaponne Klunklin12, Tamisa Manoharn1, Somsak Wanwilairat1, Wannapha Nobnop1, Anirut Watcharawipa1, Imjai Chitapanarux12
Rep Pract Oncol Radiother 2021;26(6):939-947.

Abstract

Background: With full access to both helical tomotherapy (HT) and volumetric modulated arc therapy (VMAT), we compared locally advanced non-small cell lung cancer (LA-NSCLC) treatment plans and verified the plans using patient‐specific pretreatment quality assurance (PSQA).

Materials and methods: For each of the seventeen patients included in the study, two treatment plans (i.e. HT and VMAT) were created. Optimized plans were evaluated following the ICRU 83 criteria. Planned quality indexes and dosimetric parameters were compared. Lastly, all plans were subjected to PSQA assessment by determining the gamma passing rate (GPR).

Results: All dosimetry results obtained from the planning target volume passed the ICRU 83 criteria. With regard to similar homogeneity indices, VMAT produced better conformity number values than HT (0.78 vs. 0.64), but differences in the values were insignificant. Furthermore, VMAT was associated with a significantly shorter mean treatment time (1.91 minutes vs. 6.66 minutes). For PSQA assessment, both techniques resulted in adequate GPR values (> 90% at the 3%/3 mm criteria).

Conclusion: Both HT and VMAT techniques led to the generation of clinically satisfactory and reliable radiotherapy plans. However, the VMAT plan was associated with a non-significantly better degree of conformity and a significantly shorter treatment time. Thus, VMAT was determined to be a better choice for LA-NSCLC.

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References

  1. Perez C, Pajak T, Rubin P, et al. Long-term observations of the patterns of failure in patients with unresectable non-oat cell carcinoma of the lung treated with definitive radiotherapy report by the radiation therapy oncology group. Cancer. 1987; 59(11): 1874–1881, doi: 10.1002/1097-0142(19870601)59:11<1874::aid-cncr2820591106>3.0.co;2-z.
  2. Choi N, Doucette J. Improved survival of patients with unresectable non-small-cell bronchogenic carcinoma by an innovated high-doseEn-Bloc radiotherapeutic approach. Cancer. 1981; 48(1): 101–109, doi: 10.1002/1097-0142(19810701)48:1<101::aid-cncr2820480120>3.0.co;2-s.
  3. Chun SG, Hu C, Choy H, et al. Impact of Intensity-Modulated Radiation Therapy Technique for Locally Advanced Non-Small-Cell Lung Cancer: A Secondary Analysis of the NRG Oncology RTOG 0617 Randomized Clinical Trial. J Clin Oncol. 2017; 35(1): 56–62.
  4. Cattaneo GM, Dell'oca I, Broggi S, et al. Treatment planning comparison between conformal radiotherapy and helical tomotherapy in the case of locally advanced-stage NSCLC. Radiother Oncol. 2008; 88(3): 310–318.
  5. Jiang X, Li T, Liu Y, 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.
  6. Piotrowski T, Skórska M, Jodda A, et al. Tomotherapy - a different way of dose delivery in radiotherapy. Contemp Oncol (Pozn). 2012; 16(1): 16–25.
  7. Balog J, Mackie TR, Pearson D, et al. Benchmarking beam alignment for a clinical helical tomotherapy device. Med Phys. 2003; 30(6): 1118–1127.
  8. Otto K. Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys. 2008; 35(1): 310–317.
  9. Bertelsen A, Hansen CR, Johansen J, et al. Single Arc Volumetric Modulated Arc Therapy of head and neck cancer. Radiother Oncol. 2010; 95(2): 142–148.
  10. Quan EM, Li X, Li Y, et al. A comprehensive comparison of IMRT and VMAT plan quality for prostate cancer treatment. Int J Radiat Oncol Biol Phys. 2012; 83(4): 1169–1178.
  11. Kryger M, Wang W, Wu S, et al. A Comparison of IMRT and VMAT Treatment Planning for Head and Neck Cancer With NTCP/TCP Analysis. Int J Radiat Oncol Biol Phys. 2017; 99(2): E680.
  12. Adamczyk M, Konkol M, Matecka-Nowak M, et al. 4DCT-based evaluation of lung tumour motion during the breathing cycle. Neoplasma. 2020; 67(1): 193–202.
  13. Yoon M, Park SY, Shin D, et al. A new homogeneity index based on statistical analysis of the dose-volume histogram. J Appl Clin Med Phys. 2007; 8(2): 9–17.
  14. Riet A, Mak A, Moerland M, et al. A conformation number to quantify the degree of conformality in brachytherapy and external beam irradiation: Application to the prostate. Int J Radiat Oncol Biol Phys. 1997; 37(3): 731–736.
  15. Bradley J, Paulus R, Komaki R, et al. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study. Lancet Oncol. 2015; 16(2): 187–199.
  16. Jodda A, Piotrowski T, Kruszyna-Mochalska M, et al. Impact of different optimization strategies on the compatibility between planned and delivered doses during radiation therapy of cervical cancer. Rep Pract Oncol Radiother. 2020; 25(3): 412–421.
  17. Ezzell GA, Burmeister JW, Dogan N, et al. IMRT commissioning: multiple institution planning and dosimetry comparisons, a report from AAPM Task Group 119. Med Phys. 2009; 36(11): 5359–5373.
  18. Langen KM, Papanikolaou N, Balog J, et al. AAPM Task Group 148. QA for helical tomotherapy: report of the AAPM Task Group 148. Med Phys. 2010; 37(9): 4817–4853.
  19. Xhaferllari I, El-Sherif O, Gaede S. Comprehensive dosimetric planning comparison for early-stage, non-small cell lung cancer with SABR: fixed-beam IMRT versus VMAT versus TomoTherapy. J Appl Clin Med Phys. 2016; 17(5): 329–340.
  20. Xu Y, Deng W, Yang S, et al. Dosimetric comparison of the helical tomotherapy, volumetric-modulated arc therapy and fixed-field intensity-modulated radiotherapy for stage IIB-IIIB non-small cell lung cancer. Sci Rep. 2017; 7(1): 14863.
  21. Temelli Ö, Demirtas M, Ugurlu B. Dosimetric comparison of helical tomotherapy and hybrid (3DCRT-VMAT) technique for locally advanced non-small cell lung cancer. J Radiother Pract. 2020; 20(3): 300–305.
  22. Graham M, Purdy J, Emami B, et al. Clinical dose–volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys. 1999; 45(2): 323–329.
  23. Kim TH, Cho KHo, Pyo HR, et al. Dose-volumetric parameters for predicting severe radiation pneumonitis after three-dimensional conformal radiation therapy for lung cancer. Radiology. 2005; 235(1): 208–215.
  24. Palma DA, Senan S, Tsujino K, et al. Predicting radiation pneumonitis after chemoradiation therapy for lung cancer: an international individual patient data meta-analysis. Int J Radiat Oncol Biol Phys. 2013; 85(2): 444–450.
  25. Wang K, Eblan MJ, Deal AM, et al. Cardiac Toxicity After Radiotherapy for Stage III Non-Small-Cell Lung Cancer: Pooled Analysis of Dose-Escalation Trials Delivering 70 to 90 Gy. J Clin Oncol. 2017; 35(13): 1387–1394.
  26. Dess RT, Sun Y, Matuszak MM, et al. Cardiac Events After Radiation Therapy: Combined Analysis of Prospective Multicenter Trials for Locally Advanced Non-Small-Cell Lung Cancer. J Clin Oncol. 2017; 35(13): 1395–1402.
  27. Speirs CK, DeWees TA, Rehman S, et al. Heart Dose Is an Independent Dosimetric Predictor of Overall Survival in Locally Advanced Non-Small Cell Lung Cancer. J Thorac Oncol. 2017; 12(2): 293–301.
  28. Piotrowski T, Czajka E, Bak B, et al. Tomotherapy: implications on daily workload and scheduling patients based on three years' institutional experience. Technol Cancer Res Treat. 2014; 13(3): 233–242.
  29. Low DA, Dempsey JF. Evaluation of the gamma dose distribution comparison method. Med Phys. 2003; 30(9): 2455–2464.
  30. Jodda A, Piotrowski T, Kruszyna-Mochalska M, et al. Impact of different optimization strategies on the compatibility between planned and delivered doses during radiation therapy of cervical cancer. Rep Pract Oncol Radiother. 2020; 25(3): 412–421.