A prospective trial of volumetric intensity-modulated arc therapy vs conventional intensity modulated radiation therapy in advanced head and neck cancer
A prospective trial of volumetric intensity-modulated arc therapy vs conventional intensity modulated radiation therapy in advanced head and neck cancer作者机构：Department of Radiation Medicine Roswell Park Cancer Institute University at Buffalo School of Medicine Elm and Carlton Streets Buffalo NY 14214 United States
出 版 物：《World Journal of Clinical Oncology》 (世界临床肿瘤学杂志（英文版）)
年 卷 期：2012年第3卷第4期
页 面：57-62页
学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学]
主 题：Volumetric intensity-modulated arc therapy Intensity-modulated radiation therapy Target coverage Organs at risk
摘 要：AIM: To prospectively compare volumetric intensitymodulated arc therapy(VMAT) and conventional intensity-modulated radiation therapy(IMRT) in coverage of planning target volumes and avoidance of multiple organs at risk(OARs) in patients undergoing definitive chemoradiotherapy for advanced(stage Ⅲ or Ⅳ)squamous cell cancer of the head and neck. METHODS: Computed tomography scans of 20 patients with advanced tumors of the larynx, naso-, oroand hypopharynx were prospectively planned using IMRT(7 field) and VMAT using two arcs. Calculated doses to planning target volume(PTV) and OAR were compared between IMRT and VMAT plans. Dose-volume histograms(DVH) were utilized to obtain calculated doses to PTV and OAR, including parotids, cochlea,spinal cord, brainstem, anterior tongue, pituitary and brachial plexus. DVH s for all structures were compared between IMRT and VMAT plans. In addition the planswere compared for dose conformity and homogeneity. The final treatment plan was chosen by the treating radiation oncologist. RESULTS: VMAT was chosen as the ultimate plan in 18 of 20 patients(90%) because the plans were thought to be otherwise clinically equivalent. The IMRT plan was chosen in 2 of 20 patients because the VMAT plan produced concentric irradiation of the cord which was not overcome even with an avoidance structure. For all patients, VMAT plans had a lower number of average monitor units on average(MU = 542.85) than IMRT plans(MU = 1612.58)(P 0.001). Using the conformity index(CI), defined as the 95% isodose volume divided by the PTV, the IMRT plan was more conformal with a lower conformity index(CI = 1.61) than the VMAT plan(CI = 2.00)(P = 0.003). Dose homogeneity, as measured by average standard deviation of dose distribution over the PTV, was not different with VMAT(1.45 Gy) or IMRT(1.73 Gy)(P = 0.069). There were no differences in sparing organs at ***: In this prospective study, VMAT plans were chosen over IMRT 90% of the time. Compared to IMRT, V
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