The aim of this study was to compare lateral photon–electron (LPE), helical tomotherapy (HT), and volumetric-modulated arc therapy (VMAT) plans for total scalp irradiation. We selected a single adult model case and compared the dosimetric results for the three plans. All plans mainly used 6-MV photon beams, and the prescription dose was 60 Gy in 30 fractions. First, we compared the LPE, HT and VMAT plans, with all plans including a 1-cm bolus. We also compared HT plans with and without the bolus. The conformity indices for LPE, HT and VMAT were 1.73, 1.35 and 1.49, respectively. The HT plan showed the best conformity and the LPE plan showed the worst. However, the plans had similar homogeneity indexes. The dose to the hippocampus was the highest in the VMAT plan, with a mean of 6.7 Gy, compared with 3.5 Gy in the LPE plan and 4.8 Gy in the HT plan. The doses to the optical structures were all within the clinically acceptable range. The beam-on time and monitor units were highest in the HT plan. The HT plans with and without a bolus showed similar target coverage and organ-at-risk (OAR) sparing. The HT plan showed the best target coverage and conformity, with low doses to the brain and hippocampus. This plan also had the advantage of not necessarily requiring a bolus. Although the VMAT plan showed better conformity than the LPE plan and acceptable OAR sparing, the dose to the hippocampus should be considered when high doses are prescribed.

PurposeWe aim to evaluate the effects of multileaf collimator (MLC) leaf width (5 mm vs. 2.5 mm) on the radiosurgery planning for the treatment of spine lesions according to the modulated techniques (intensity-modulated radiotherapy [IMRT] vs. volumetric-modulated arc therapy [VMAT]) and the complexity of the target shape.MethodsFor this study, artificial spinal lesions were contoured and used for treatment plans. Three spinal levels (C5, T5, and L2 spines) were selected, and four types of target shapes reflecting the complexity of lesions were contoured. The treatment plans were performed using 2.5-mm and 5-mm MLCs, and also using both static IMRT and VMAT. In total, 48 treatment plans were established. The efficacy of each treatment plan was compared using target volume coverage (TVC), conformity index (CI), dose gradient index (GI), and V30%.ResultsWhen the 5-mm MLC was replaced by the 2.5-mm MLC, TVC and GI improved significantly by 5.68% and 6.25%, respectively, while CI did not improve. With a smaller MLC leaf width, the improvement ratios of the TVC were larger in IMRT than VMAT (8.38% vs. 2.97%). In addition, the TVC was improved by 14.42-16.74% in target type 4 compared to the other target types. These improvements were larger in IMRT than in VMAT (27.99% vs. 6.34%). The V30% was not statistically different between IMRT and VMAT according to the MLC leaf widths and the types of target.ConclusionThe smaller MLC leaf width provided improved target coverage in both IMRT and VMAT, and its improvement was larger in IMRT than in VMAT. In addition, the smaller MLC leaf width was more effective for complex-shaped targets.

We analyzed the difference in the dosimetric effect between 5-mm and 2.5-mm multileaf collimator (MLC) leaf width according to the sophisticated grades of intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT). Nineteen patients with pituitary adenomas were selected for this study. The treatment plans were performed according to the size of the MLC (5-mm and 2.5-mm MLC), the type of technique (IMRT and VMAT), and the sophisticated grades of each technique (5-field, 9-field, 13-field, 17-field technique in IMRT and 1-arc and 2-arc techniques in VMAT). The downsizing effects of MLC leaf width were analyzed using target volume coverage (TVC), conformity index (CI), dose gradient index (GI), and normal tissue difference 70% isodose line and 50% isodose line. Upon replacing the 5-mm MLC with the 2.5-mm MLC, TVC and CI improved by 1.30% and 1.36%, respectively, in total plans. The TVC and CI improved by 1.68% and 1.67% in IMRT, respectively, and by 0.54% and 0.72% in VMAT, respectively. TVC improved by 2.53%, 1.82%, 1.34%, and 0.94%, and CI also improved by 2.70%, 1.81%, 1.24%, and 0.94%, in 5-field, 9-field, 13-field, and 17-field IMRT, respectively. TVC improved by 0.66% and 0.43%, and CI also improved by 0.93%, and 0.52% in 1-arc and 2-arc VMAT, respectively. Regarding the target coverage, there were dosimetric benefits of a smaller MLC leaf width. However, the downsizing effect of the MLC leaf width decreased with the use of a more precise RT technique and a more sophisticated grade of the same technique.

BackgroundTo create an arc therapy plan, certain current general calculation algorithms such as pencil-beam calculation (PBC) are based on discretizing the continuous arc into multiple fields to simulate an arc. The iPlan RT™ treatment planning system incorporates not only a PBC algorithm, but also a more recent Monte Carlo calculation (MCC) algorithm that does not need beam discretization. The objective of this study is to evaluate the dose differences in a homogenous phantom between PBC and MCC by using a three-dimensional (3D) diode array detector (ArcCHECK™) and 3DVH software.MethodsA cylindrically shaped ‘target’ region of interest (ROI) and a ‘periphery ROI’ surrounding the target were designed. An arc therapy plan was created to deliver 600 cGy to the target within a 350° rotation angle, calculated using the PBC and MCC algorithms. The radiation doses were measured by the ArcCHECK, and reproduced by the 3DVH software. Through this process, we could compare the accuracy of both algorithms with regard to the 3D gamma passing rate (for the entire area and for each ROI).ResultsComparing the PBC and MCC planned dose distributions directly, the 3D gamma passing rates for the entire area were 97.7% with the gamma 3%/3 mm criterion. Comparing the planned dose to the measured dose, the 3D gamma passing rates were 98.8% under the PBC algorithm and 100% under the MCC algorithm. The difference was statistically significant (p = 0.034). Furthermore the gamma passing rate decreases 7.5% in the PBC when using the 2%/2 mm criterion compared to only a 0.4% decrease under the MCC. Each ROI as well as the entire area showed statistically significant higher gamma passing rates under the MCC algorithm. The failure points that did not satisfy the gamma criteria showed a regular pattern repeated every 10°.ConclusionsMCC showed better accuracy than the PBC of the iPlan RT in calculating the dose distribution in arc therapy, which was validated with the ArcCHECK and the 3DVH software. This may suggest that the arc step of 10° is too large in the PBC algorithm in the iPlan RT.

Radiation therapy is one of the most important therapeutic modalities for the treatment of lung cancer. Radiation pneumonitis is one of the important complications associated with radiotherapy for lung cancer. Radiation pneumonitis is generally limited to the irradiated lung and is manifested by the insidious onset of dry cough, dyspnea, and mild fever, resulting in damage and edematous changes of alveolar structures on histologic inspection. Clinically, diffuse bilateral radiation pneumonitis accompanied with acute symptoms after unilateral thoracic irradiation appears very rarely. Histopathologic examinations for the diagnosis of out-of-field radiation pneumonitis are rarely performed. We herein describe a case of extensive bilateral radiation pneumonitis which developed acutely after salvage radiotherapy for squamous cell carcinoma in the left upper lobe of the lung. The condition was confirmed by a diagnostic help of histopathologic findings. (J Lung Cancer 2012;11(2):97 101)

Bronchomediastinal fistula is an extremely rare complication resulting from diseases such as mediastinitis or mediastinal malignancies. In patients with lung cancer, bronchomediastinal fistula formation has rarely been reported, except during postchemotherapy or post-radiation therapy complications. An 84-year-old visited our hospital to receive palliative radiation therapy for squamous cell carcinoma of the right main bronchus T4N2M1a. During an early course of radiation therapy, chest computed tomography (CT) scans revealed bronchomediastinal fistula between the right main bronchus and the enlarged sub-carinal lymph nodes. Radiation therapy was, therefore, discontinued and the patient received only supportive care.