Comparison of Rapid to Standard Volumetric Modulated Arc Therapy for Palliative Radiotherapy in Lung Cancer Patients

Abstract

Patients with incurable lung cancer often present with debilitating symptoms that require urgent palliative radiotherapy. Volumetric modulated arc therapy (VMAT) provides several dosimetric advantages compared to basic non-conformal techniques, but involves complex planning resulting in a slower turnaround time for treatment. A simplified planning technique known as 'rapid VMAT' was developed with an aim to deliver palliative treatment to patients within 48 hours. The purpose of this study was to prospectively compare the dosimetric quality of rapid VMAT plans to standard VMAT plans. Fourteen consecutive rapid VMAT cases were re-planned de novo as per standard VMAT planning guidelines. Planning target volume (PTV) and organs at risk (OARs) were then compared. PTV coverage and dose to OARs including the spinal canal, lung, heart, and esophagus were similar between rapid and standard VMAT. Each plan was ready for treatment within 48 hours of the CT simulation. This study describes an expedited process for which palliative radiotherapy can be delivered to lung tumors with a similar robust quality that is provided for curative intent VMAT radiotherapy plans.

Palliative Radiation for Advanced Central Lung Tumors With Intentional Avoidance of the Esophagus (PROACTIVE)

“…First, ES-IMRT takes more time to design and therefore may not be appropriate in the scenario in which more urgent thoracic RT is indicated. Technological advances, however, will allow ES-IMRT to be designed within 48 hours . Second, ES-IMRT is likely to be more costly, and cost-effectiveness will be the topic of a future study on the PROACTIVE cohort.…”

“…Technological advances, however, will allow ES-IMRT to be designed within 48 hours. 13 Second, ES-IMRT is likely to be more costly, and costeffectiveness will be the topic of a future study on the PROACTIVE cohort. Third, the ES-IMRT technique we describe herein represents a paradigm shift in palliative RT planning.…”