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Dosimetric comparison of 3-dimensional conformal radiotherapy (3D-CRT) and volumetric-modulated arc therapy (VMAT) in locally advanced cancer cervix

Published online by Cambridge University Press:  06 October 2020

Animesh Agrawal ,
Rahat Hadi Open the ORCID record for Rahat Hadi [Opens in a new window] ,
Satyajeet Rath Open the ORCID record for Satyajeet Rath [Opens in a new window] ,
Avinav Bharati ,
Madhup Rastogi ,
Rohini Khurana ,
Kamal Sahni ,
Shantanu Sapru ,
Ajeet Kumar Gandhi  and
Anoop Kumar Srivastava
...Show all authors
Animesh Agrawal
Affiliation:
Department of Medical Oncology, Gujarat Cancer Research Institute, Ahmedabad, India
Rahat Hadi*
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Satyajeet Rath
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Avinav Bharati
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Madhup Rastogi
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Rohini Khurana
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Kamal Sahni
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Shantanu Sapru
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Ajeet Kumar Gandhi
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Anoop Kumar Srivastava
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Surendra Prasad Mishra
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
*
Author for correspondence: Rahat Hadi, Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India. Tel: 8858826619. E-mail: [email protected]
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Abstract

Introduction:

Dosimetric advantages of volumetric-modulated arc therapy (VMAT) over three-dimensional conformal radiotherapy (3D-CRT) are not established in a head-on comparison of a uniform group of locally advanced carcinoma of the cervix (LACC). Therefore, we conducted a dosimetric comparison of these two techniques in LACC patients.

Materials and methods:

Computed tomography (CT) data of histologically proven de novo LACC, including Stage IIB–IIIB and earlier stages deemed inoperable, were included in this prospective observational dosimetric study. Planning was initially done by 3D-CRT technique (dose of 45–50·4 Gy @ 1·8–2 Gy/# was used in the actual treatment), followed by VMAT planning and appropriate dosimetric comparisons were done in 39 cases.

Results:

For planning target volume coverage, D95, D98 and D100 (p < 0·0001 for all parameters) and V95 and V100 (p = 0·002 and <0·0001, respectively) were significantly improved with VMAT. The conformity index (CI) was significantly better with VMAT (p = 0·03), while 3D-CRT had a significantly better homogeneity index (HI)(p = 0·003). Dose to the urinary bladder was significantly reduced with VMAT compared to 3D-CRT for V20–V50, except V10. The doses to the rectum and abdominal cavity were significantly reduced with VMAT compared to 3D-CRT plans for all parameters (V10–V50). The number of organs at risks (OARs) for which constraints were met was higher with VMAT plans than with 3D-CRT plans, with at least four out of the five OARs protected in 46·1 versus 5·1% and all constraints achieved in 15·4% versus none.

Conclusion:

We conclude that in dosimetric terms, VMAT is superior to 3D-CRT for LACC.

Keywords

carcinoma cervixdosimetryVMAT3D-CRTLACC
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 1 , March 2022 , pp. 60 - 67
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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