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Trajectory modulated arc therapy using quasi-continuous couch motion layered on top of volumetric modulated arc therapy in left breast and chest wall irradiation: a feasibility study

Published online by Cambridge University Press:  23 January 2017

Biplab Sarkar  and
Anirudh Pradhan
Biplab Sarkar*
Affiliation:
Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, HaryanaIndia Department of Physics, GLA University Mathura, Uttar Pradesh, India
Anirudh Pradhan
Affiliation:
Dean (Research and Development) GLA University Mathura, Uttar Pradesh, India
*
Correspondence to: Biplab Sarkar, Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana 122002, India. Tel: +919560128094; E-mail: [email protected]
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Abstract

Aim

To investigate the dosimetric advantage of quasi-continuous couch motion-enabled trajectory modulated arc radiotherapy therapy (TMAT) over the coplanar tangential partial arcs volumetric modulated arc radiotherapy (VMAT) for treating left breast and chest wall patients.

Method

Treatment plans of 43 patients who received radiotherapy for left breast (17) or for left chest wall (26) using coplanar partial tangential arcs VMAT (reference plan) were considered for this study. For each patient, in addition to the treatment plan, a TMAT plan was also generated using quasi-continuous couch rotation. The TMAT plan consisted of original two 30° tangential arc beams and two supplementary beams having a couch rotation of ±10°, ±20° and ±30°, respectively. The difference in PTV volume coverage (PTV V95%) between TMAT plan and VMAT plan was calculated for all the cases and normalised to the plan’s prescription dose. Similarly, differences in PTV_V105% and several dose-volume parameters related to organs at risk (OAR) were also computed and tabulated.

Result

TMAT shows an increment in the PTV dose coverage V95% with respect to reference plan by 4·7±2·5% when averaged overall prescription dose levels. Mean PTV dose (averaged overall prescription levels) for reference and TMAT plan was 4638·6±423·8 and 4793·5±447·2 cGy, respectively, and statistically insignificant (p=0·06). However mean PTV_V105% values for TMAT and for reference plans were 6·7±4·8 and 7·2±5·2%, respectively, and were not statistically different (p=0·85). Mean heart dose in TMAT was less than in VMAT plans, but not significantly. As regarding D1% to heart, TMAT plan was again found to be better with a mean difference of 137·1 cGy over VMAT plan. Other parameters evaluated were: mean dose and D1% to contralateral breast, and V20 Gy and V5 Gy for lung.

Conclusion

TMAT plans were found to be better than VMAT plans in terms of PTV coverage and D1% for heart. For evaluated dose parameters apart from PTV coverage and D1% to the heart, no significant differences were observed. Thus, TMAT plans yielded better dose distribution in terms of PTV dose coverage, hot spots and OAR doses.

Keywords

breast radiotherapycouch rotationTMATtrajectory modulated arc therapyVMAT
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 2 , June 2017 , pp. 133 - 140
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Copyright
© Cambridge University Press 2017 

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