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Dosimetric comparison of constant dose rate volumetric modulated arc therapy (CDR-VMAT) and intensity-modulated radiation therapy (IMRT) for gallbladder cancer

Published online by Cambridge University Press:  29 December 2020

Varsha R. Gedam Open the ORCID record for Varsha R. Gedam [Opens in a new window]  and
Anirudh Pradhan
Varsha R. Gedam*
Affiliation:
Department of Medical Physics, Delhi State Cancer Institute, Dilshad Garden, Delhi; Department of Physics, GLA University, Mathura, India
Anirudh Pradhan
Affiliation:
Department of Mathematics, GLA University, Mathura, Uttar Pradesh, India
*
Author for correspondence: Varsha R. Gedam, Department of Medical Physics, Delhi State Cancer Institute, Dilshad Garden, Delhi, 110095. E-mail: [email protected]
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Abstract

Aim:

To study the feasibility of constant dose rate volumetric modulated arc therapy (CDR-VMAT) in radiotherapy for gallbladder cancer by comparing dosimetric parameter suggested by International Commission on Radiation Units and Measurements-83 (ICRU-83) with step and shoot intensity-modulated radiation therapy (SS IMRT).

Methods:

For this study, we selected 21 post-operative gallbladder cancer patients, which were treated with the IMRT technique from 2016 to 2019. For each patient, we generated SS IMRT plan and CDR-VMAT plan and were dosimetrically compared by parameters suggested by ICRU-83 for PTV. Homogeneity Index (HI) and Conformity Index (CI) were also calculated. For evaluation of Organ at Risk (OAR), we compared the mean doses, volume doses to the right kidney, left kidney, both kidneys combined, liver and max dose to the spinal cord. Monitor units (MUs) and treatment delivery time were also compared.

Results:

On comparing, we found that CDR-VMAT plans were highly conformed as CI and PCI (CI define by Paddick) were found more (0·98 ± 0·01 vs. 0·97 ± 0·03 and 0·86 ± 0·05 vs. 0·85 ± 0·05) than IMRT plans but not statistically significant. Better dose HI was found for IMRT plans with statistical significant difference (p < 0·001). The tumour coverage was found similar 98·24% and 97·83% for SS IMRT and CDR-VMAT, respectively. For D2%, the maximum dose to PTV was significantly lower in IMRT (p = 0·001). D50% and mean dose to PTV were also comparable to IMRT with no statistically significant difference. The OAR parameters were comparable in both the techniques. The mean doses and volume doses V10, V20 and V30 to the right kidney, left kidney and liver were also comparable with no significant difference (p > 0·05) was noted among them. However, the maximum dose to the spinal cord was significantly less in CDR-VMAT (21·1 Gy vs. 25·1Gy) than SS IMRT with p = 0·006. More MUs were associated with the CDR-VMAT technique, but shorter treatment delivery time than the IMRT technique.

Conclusions:

On dosimetric comparison of two treatment techniques, we conclude that CDR-VMAT can be a valid option in radiotherapy as it achieved highly conformed dose distribution, comparable tumour coverage and OAR sparing as IMRT technique for gallbladder cancer.

Keywords

IMRTCDR-VMAThomogeneity indexDosimetric comparisonconformity indexGall Bladder Cancer
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 2 , June 2022 , pp. 228 - 233
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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