Dosimetric evaluation of VMAT for palliative radiotherapy for non-small cell lung carcinoma

Iqbal, Muhammad Shahid; Richmond, Neil D.; Ogilvie, A.; Pilling, K.; Willis, Nicholas A.; Byrne, John; Walker, Christopher; West, Nick

doi:10.1259/bjr.20180146

Cited by 4 publications

(3 citation statements)

References 9 publications

(7 reference statements)

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“…For palliative lung treatments, Iqbal et al described improved PTV coverage and homogeneity with VMAT compared to a parallel opposed pair. There was no difference in the dose delivered to OARs; however, these structures were not included in the optimization process [6]. Our planning technique allowed ROs to select constraints for two OARs, but did not compare the subsequent dosimetry to the standard parallel opposed pair as the dosimetric advantages were expected based on a prior planning study in the radical setting [8].…”

Section: Discussionmentioning

confidence: 99%

“…As the use of volumetric modulated arc therapy (VMAT) becomes more widespread, interest in utilizing this advanced technique for treatments with palliative intent in an effort to decrease toxicity has grown [5][6][7]. While VMAT is associated with several dosimetric advantages that may translate into improved outcomes for patients, the technique involves complex planning and quality assurance that can strain department resources and result in slower turn-around times for patient treatments, which may often be unacceptable for symptomatic palliative patients.…”

Section: Introductionmentioning

confidence: 99%

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

Mak¹,

Fraser²,

Ferris³

et al. 2020

Cureus

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Mak¹,

Fraser²,

Ferris³

et al. 2020

Cureus

View full text Add to dashboard Cite

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“…The biggest difference from fixed-field IMRT is that, with VMAT, it is possible to coordinate the dose rate, multileaf collimator movement and gantry rotation at the same time. Apart from these advantages, VMAT has also been shown to achieve an improved dose distribution with decreasing treatment time in numerous types of cancer (e.g., in prostate, locally advanced lung carcinoma and various head and neck cancer applications) (13)(14)(15)(16)(17). The hybrid-IMRT (h-IMRT) technique, which is discussed in the present study, comprises a combination of 3D-CRT and IMRT, and a previous study has suggested that this technique can improve the plan quality when an appropriate ratio between the use of 3D-CRT and IMRT is set; in the study, the conventional component consisted of a nominal fraction dose of 1.8 Gy; the IMRT component consisted of a nominal 0.2 Gy per fraction, and in this ratio, compared to 3D-CRT, using the h-IMRT technique can improve the PTV coverage and avoid hot spots (18).…”

Section: Introductionmentioning

confidence: 99%

Dosimetric comparison of four radiotherapy techniques for stage III non‑small cell lung cancer

Luo

Song

et al. 2023

Oncol Lett

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The present study was implemented to compare the dosimetric parameters of the target dose coverage and critical structures in the treatment planning of four radiotherapy techniques [namely, three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), hybrid IMRT (h-IMRT) and volumetric-modulated arc therapy (VMAT)] for stage III non-small cell lung cancer (NSCLC) qualified plans for medical physicists, therapists and physicians. A total of 40 patients confirmed to have stage IIIA or IIIB NSCLC were enrolled, and four plans were designed for each patient. The prescription dose to the planning target volume (PTV) was assigned as 60 Gy in 30 fractions. The conformity index (CI), heterogeneity index (HI) and parameters of organs at risk (OARs) were calculated. For the PTV, the CI for VMAT was found to be the highest of all the four techniques (P<0.05), whereas the HI for the h-IMRT technique was found to be the lowest (P<0.05). Concerning the OARs, for the percentage of lung volume receiving a dose >5 Gy (lung V 5 ), the highest value was obtained with VMAT (P<0.05), whereas for lung V 30 and heart V 30 , the VMAT and IMRT techniques were found to be better compared with 3D-CRT and h-IMRT (P<0.05). For esophagus V 50 , the maximal dose (D max ) and mean dose for the IMRT technique displayed the best results (P<0.05), and in the case of the spinal cord, the D max with VMAT showed a significant advantage over the other techniques (P<0.05). The treatment monitor units (MUs) in IMRT were found to be the largest (P<0.05), whereas the treatment time with VMAT was the shortest (P<0.05). For smaller PTVs, VMAT was the technique that provided the optimal dose distribution and sparing of the heart. Compared with 3D-CRT alone, adding 20% IMRT to the 3D-CRT base plan was shown to improve the plan quality, and IMRT and VMAT, as techniques, had better dose coverage and sparing of OARs. Furthermore, for patients in whom the lung V5 could be kept low enough, VMAT potentially offered a good alternative to the technique to IMRT, thereby offering additional possibilities for sparing of other OARs, and decreasing the MUs and treatment time.

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The feasibility of telephone follow-up calls after radical radiotherapy for adult patients at leeds cancer centre

Bradder

2020

Radiography

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A critical review of the evidence identified consensus referral criteria and outcome data against which to audit patients. Results: Referral criteria were derived from six published studies. These applied to patients unfit for surgery or stoma-averse. All referred patients had a visible tumour or scar with a tumour size under 3cm and sited less than 12cm from the anal verge. Nodal status varied from N0 to N2 but there was no metastatic disease present. The audited cohort demonstrated equivalence of median age, performance status, and tumour stage. Initial clinical complete response (cCR), local recurrence, and occurrence of distant metastases were also comparable. Conclusion and Discussion: Similarity of cohort demographics enabled comparison of outcome data which confirmed the validity of referral and treatment protocols. Although the limited evidence base and retrospective nature of the audit limits the strength of the findings, until evidence from ongoing studies becomes available this work should guide future referrals in the interim and contribute to development of robust national guidelines. Numerical References 1. Myint, A.S. (2017) Do patients have a choice? Oncology News.12(1), 4-6; 2. National Institute for Health and Care Excellence. (2015) Low energy contact x-ray brachytherapy (the Papillon technique) for early stage rectal cancer. NICE Interventional procedures guidance (IPG532); NICE: London

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Dosimetric evaluation of VMAT for palliative radiotherapy for non-small cell lung carcinoma

Abstract: With the help of modern VMAT techniques, it is possible to effectively achieve highly conformal dose delivery which may provide an opportunity to escalate the dose to the tumour in this group of patients.

Cited by 4 publications

References 9 publications

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

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

Dosimetric comparison of four radiotherapy techniques for stage III non‑small cell lung cancer

The feasibility of telephone follow-up calls after radical radiotherapy for adult patients at leeds cancer centre

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