Evaluation of field-in-field, three-field, and four-field techniques for treatment planning of radiotherapy of pancreatic cancer

Abstract

Background: Pancreatic adenocarcinoma is a lethal condition with poor outcomes by various treatment modalities and an increasing incidence. Aim: The aim of this study is to evaluate the advantages of field-in-field (FIF) versus three-field and four-field radiation treatment planning techniques in three-dimensional treatment of patients with pancreatic cancer. Materials and Methods: The evaluations of these planning techniques were performed in terms of physical and biological criteria. Radiotherapy treatment data of 20 patients with pancreatic cancer were selected and evaluated for FIF, three-field, and four-field treatment techniques. The patients were treated by 6 MV photon beam of a medical linac, and these three treatment planning techniques were evaluated for all the 20 patients. The plans were compared based on dose distribution in the target volume, monitor unit (MU), and dose to organs at risk (OARs). Results: The results have shown that, with assuming the same prescribed dose to planned target volume, FIF plans have some advantages over three-field and four-field treatment plans, based on MU values, V20 Gy in the right lung, V20 Gy in the left lung, Dmean in the left kidney, Dmean in the liver, and Dmean in the spinal cord. Based on the obtained results, the use of FIF technique reduces MUs compared to the three-field and four-field techniques. Conclusion: Having a less MU for performing treatment reduces scattered radiation and therefore reduces the risk of secondary cancer in normal tissues. In addition, the use of FIF technique has advantage of less radiation dose to some OARs.