Prog Med Phys.  2020 Dec;31(4):179-188. 10.14316/pmp.2020.31.4.179.

Dosimetric Comparison of Noncoplanar and Coplanar Volumetric Modulated Arc Therapy Plans for Esophageal Cancer

• Park SY

• KMID: 2510479
• DOI: http://doi.org/10.14316/pmp.2020.31.4.179

Abstract

Purpose
We compared noncoplanar volumetric modulated arc therapy (ncVMAT) plans to coplanar VMAT (cVMAT) plans by evaluating the dosimetric quality of each for esophageal cancer.
Methods
Twenty patients treated for esophageal cancer with the cVMAT technique were retrospectively selected. The cVMAT plans consisted of three coplanar full arc beams. The ncVMAT plans consisted of two coplanar full arc beams and one noncoplanar partial arc beam ranging from 45° to 315° with a couch rotation angle of 315°±5°. For dosimetric evaluation, the dose-volumetric (DV) parameters of the planning target volume (PTV) and organs at risk (OARs) were calculated for all VMAT plans.
Results
No clinically noticeable differences between the cVMAT and ncVMAT plans were observed in the DV parameters of the PTV. For the lungs, the V _{13 Gy} and mean dose for ncVMAT plans were smaller than those for cVMAT plans, showing statistically significant differences. For the heart, the values of the maximum dose for cVMAT and ncVMAT plans were 53.8±2.9 and 50.9±3.3 Gy, respectively (p=0.004). For the spinal cord, the values of the maximum dose for cVMAT and ncVMAT plans were 37.1±5.1 and 34.7±5.7 Gy, respectively (p<0.001).
Conclusions
The use of ncVMAT plans provides better PTV coverage and sparing of OARs compared to that of cVMAT plans for long, tube-like esophageal cancer. For esophageal cancer, the ncVMAT plans showed a more favorable plan quality than the cVMAT plans.

Keyword

Dosimetric evaluation; Noncoplanar; Volumetric modulated arc therapy; Esophageal cancer

Figure

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  Fig. 1 Examples of a long, tube-shaped planning target volume (PTV) of esophageal cancer surrounding critical organs at risk such as left and right lungs, heart, and spinal cord for patients #1 (a) and #3 (b). Cyan, green, magenta, red, and pink colors represent the PTV, left and right lungs, heart, and spinal cord, respectively.

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  Fig. 2 Arc beam geometry comparison for coplanar (a) and noncoplanar (b) volumetric modulated arc therapy (VMAT) plans.

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  Fig. 3 For representative patient cases (patient #3 and #9), calculated dose distributions in the axial, coronal, and sagittal views of coplanar volumetric modulated arc therapy (cVMAT) plans (a) and noncoplanar VMAT (ncVMAT) plans (b) of patient #3, and cVMAT (c) and ncVMAT (d) of patient #9.

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  Fig. 4 For both coplanar volumetric modulated arc therapy (cVMAT) and noncoplanar VMAT (ncVMAT) plans, the dose-volume histograms (DVHs) of the planning target volume (PTV) and lungs of the patient #3 (a) and #9 (c) are shown. The DVHs of the other organs at risk (OARs) of the patient #3 (b) and #9 (d) are shown. The cVMAT and ncVMAT plans are plotted with the solid and dashed lines, respectively. SC, spinal cord.

Reference

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