Hostname: page-component-6bf8c574d5-w79xw Total loading time: 0 Render date: 2025-02-16T16:27:57.272Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of split X-jaw technique on target volume coverage and organ at risk sparing in prostate cancer: a comparative dosimetric study

Published online by Cambridge University Press:  13 May 2022

Gautam Sarma Open the ORCID record for Gautam Sarma [Opens in a new window] ,
Jyotiman Nath Open the ORCID record for Jyotiman Nath [Opens in a new window] ,
Shachindra Goswami Open the ORCID record for Shachindra Goswami [Opens in a new window] ,
Pranjal Goswami Open the ORCID record for Pranjal Goswami [Opens in a new window] ,
Shashi Bhushan Sharma Open the ORCID record for Shashi Bhushan Sharma [Opens in a new window]  and
Apurba Kumar Kalita Open the ORCID record for Apurba Kumar Kalita [Opens in a new window]
Gautam Sarma
Affiliation:
Department of Radiation Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
Jyotiman Nath
Affiliation:
Department of Radiation Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
Shachindra Goswami
Affiliation:
Department of Radiation Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
Pranjal Goswami
Affiliation:
Department of Radiation Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
Shashi Bhushan Sharma*
Affiliation:
Department of Radiation Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
Apurba Kumar Kalita
Affiliation:
Department of Radiation Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
*
Author for Correspondence: Shashi Bhushan Sharma, Dr Bhubaneswar Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam 781016, India. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

The Varian Trilogy linear accelerator’s multi-leaf collimator moves on a carriage with a maximum leaf span of 15 cm. The traditional open and limited X-jaw technique of volumetric-modulated arc radiotherapy (VMAT) yields a relatively compromised dose distribution within the planning target volume (PTV) region. This study aimed to determine whether the split X-jaw planning technique for VMAT improves plan quality regarding target dose coverage and organs at risk (OAR) sparing for PTVs that require a field size of more than 15 cm in the X-jaw direction in prostate cancer patients.

Method:

Computed tomography data sets from 15 patients with prostate cancer were enrolled in the study. Only the PTVs requiring a field size larger than 18 cm in the X-jaw position were considered, and a dose of 4500 cGy in 25 fractions was prescribed. For each case, three separate treatment plans were generated: open, limited and split X-jaw planning techniques with similar planning objectives

Results:

The split X-jaw technique resulted in statistically significant superior coverage of PTV when compared with the open (P < 0·0001) and limited methods (P < 0·001). The split technique delivered a lower dose to the OARs, although statistical significance could not be achieved. D2% (cGy) was lowest for the PTV in the split technique (4684·8 ± 18·16) and highest for the open technique (4710 ± 18·75), P < 0·001.

Conclusion:

The x-split jaw technique can replace the traditional open X-jaw practice of VMAT for PTVs requiring an X-jaw width of more than 15 cm in the Varian linear accelerator.

Keywords

multi-leaf collimatorprostate radiotherapysplit X-jawvarianVMAT
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e41
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bedford, JL. Treatment planning for volumetric modulated arc therapy. Med Phys 2009; 36: 5128–5138.CrossRefGoogle ScholarPubMed
Otto, K. Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys 2008; 35: 310–317.CrossRefGoogle Scholar
Cozzi, L, Dinshaw, KA, Shrivastava, SK et al. A treatment planning study comparing volumetric arc modulation with RapidArc and fixed field IMRT for cervix uteri radiotherapy. Radiother Oncol 2008; 89: 180–191.CrossRefGoogle ScholarPubMed
Vanetti, E, Clivio, A, Nicolini, G et al. Volumetric modulated arc radiotherapy for carcinomas of the oropharynx, hypo-pharynx and larynx: a treatment planning comparison with fixed field IMRT. Radiother Oncol 2009; 92: 111–117.CrossRefGoogle ScholarPubMed
Shaffer, R, Nichol, AM, Vollans, E et al. A comparison of volumetric modulated arc therapy and conventional intensity-modulated radiotherapy for frontal and temporal high-grade gliomas. Int J Radiat Oncol Biol Phys 2010; 76: 1177–1184.CrossRefGoogle ScholarPubMed
Zhang, PP, Happersett, L, Hunt, M et al. Volumetric modulated arc therapy: planning and evaluation for prostate cancer cases. Int J Radiat Oncol Biol Phys 2010; 76: 1456–1462.CrossRefGoogle ScholarPubMed
Kopp, RW, Duff, M, Catalfamo, F, Shah, D, Rajecki, M, Ahmad, K. VMAT versus 7-field-IMRT: assessing the dosimetric parameters of prostate cancer treatment with a 292-patient sample. Med Dosim 2011; 36: 365–372.CrossRefGoogle Scholar
Yoo, S, Wu, QJ, Lee, WR, Yin, FF. Radiotherapy treatment plans with RapidArc for prostate cancer involving seminal vesicles and lymph nodes. Int J Radiat Oncol Biol Phys 2010, 76: 935–942.CrossRefGoogle ScholarPubMed
Vieillot, S, Azria, D, Lemanski, C et al. Plan comparison of volumetric-modulated arc therapy (RapidArc) and conventional intensity-modulated radiation therapy (IMRT) in anal canal cancer. Radiat Oncol 2010; 5: 92.CrossRefGoogle Scholar
Huang, B, Fang, Z, Huang, Y et al. A dosimetric analysis of volumetric-modulated arc radiotherapy with jaw width restriction vs 7 field intensity-modulated radiotherapy for definitive treatment of cervical cancer. Br J Radiol 2014; 87 (1039): 20140183.CrossRefGoogle ScholarPubMed
Zhang, WZ, Lu, ZY, Chen, JZ et al. A dosimetric study of using fixed-jaw vol- umetric modulated arc therapy for the treatment of nasopharyngeal carcinoma with cervical lymph node metastasis. PLoS One 2016; 11 (5): e0156675.CrossRefGoogle Scholar
Keil, J, Carda, J, Reihart, J, Seidel, M, Lenards, N, Hunzeker, A. A dosimetric study using split x-jaw planning technique for the treatment of endometrial carcinoma. Med Dosimetr 2020; 45 (3): 278–283.CrossRefGoogle ScholarPubMed
Sung, H, Ferlay, J, Siegel, R et al. (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer J Clin 71 (3): 209–249.Google ScholarPubMed
Salembier, C, Villeirs, G, De Bari, B et al. ESTRO ACROP consensus guideline on CT- and MRI-based target volume delineation for primary radiation therapy of localized prostate cancer. Radiother Oncol 2018; 127 (1): 49–61.CrossRefGoogle Scholar
Shaw, E, Kline, R, Gillin, M et al. Radiation therapy oncology group: radiosurgery quality assurance guidelines. Int J Radiat Oncol*Biol*Phys 1993; 27 (5): 1231–1239.CrossRefGoogle ScholarPubMed
Atiq, M, Atiq, A, Iqbal, K, Shamsi, Q, Andleeb, F, Buzdar, S. Evaluation of dose conformity and coverage of target volume for intensity-modulated radiotherapy of pelvic cancer treatment. Indian J Cancer 2017; 54 (1): 379–384.CrossRefGoogle ScholarPubMed
Hodapp, N. Der ICRU-Report 83: verordnung, Dokumentation und Kommunikation der fluenzmodulierten Photonenstrahlentherapie (IMRT). Strahlenther Onkol 2012; 188: 97–100.CrossRefGoogle ScholarPubMed
Teoh, M, Clark, C, Wood, K, Whitaker, S, Nisbet, A. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiology. 2011; 84 (1007): 967–996.CrossRefGoogle ScholarPubMed