A comparative study of standard intensity-modulated radiotherapy and RapidArc planning techniques for ipsilateral and bilateral head and neck irradiation
A comparative study of standard intensity-modulated radiotherapy and RapidArc planning techniques for ipsilateral and bilateral head and neck irradiation
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DOI：
10.1016/j.meddos.2016.10.004
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发表时间：
2017-03-01
影响因子：
1.2
通讯作者：
Tishler, Roy B.
中科院分区：
文献类型：
--
作者：
Pursley, Jennifer;Damato, Antonio L.;Tishler, Roy B.
本研究的目的是调查类解决方案使用RapidArc体积调制弧形治疗（VMAT）计划同侧和双侧头颈部（H&N）照射，并比较剂量测定结果与调强放疗（IMRT）计划。共14例接受同侧照射的患者和10例接受双侧头颈部照射的患者采用几种体积调制弧形治疗技术进行回顾性重新计划。对于同侧颈部照射，体积调制弧治疗技术包括两个360弧，两个360弧与对侧腮腺周围的回避扇区，两个260或270弧，和两个210弧。对于双侧颈部照射，体积调节弧治疗技术包括两个360弧，两个360弧与回避扇区周围的肩膀，和3弧。所有患者都有一个滑动窗口输送调强放疗计划，作为剂量比较的基准。对于同侧颈部照射，使用两个360度弧的体积调制弧治疗技术在对侧腮腺周围具有回避扇区，在剂量学上与强度调制放射治疗相当，具有改善的一致性（一致性指数= 1.22 vs 1.36，p < 0.04）和较低的对侧腮腺平均剂量（5.6 vs 6.8戈伊，p < 0.03）。对于双侧颈部照射，3弧体积调制弧治疗技术在剂量学上与强度调制放射治疗相当，同时还避免了通过肩部的照射。所有体积调制弧形治疗技术需要比滑动窗口强度调制放射治疗更少的监视器单元来提供治疗，同侧计划平均减少35%，双侧计划平均减少67%。因此，对于同侧头部和颈部照射，推荐使用两个360度弧的体积调制弧治疗技术，其中对侧腮腺周围具有回避扇区。对于双侧颈部照射，2弧或3弧技术在剂量学上与调强放疗相当，但需要更多的工作来确定疾病部位的最佳方法。(C)2017年美国医学剂量学家协会。
The purpose of this study was to investigate class solutions using RapidArc volumetric-modulated arc therapy (VMAT) planning for ipsilateral and bilateral head and neck (H&N) irradiation, and to compare dosimetric results with intensity-modulated radiotherapy (IMRT) plans. A total of 14 patients who received ipsilateral and 10 patients who received bilateral head and neck irradiation were retrospectively replanned with several volumetric-modulated arc therapy techniques. For ipsilateral neck irradiation, the volumetric-modulated arc therapy techniques included two 360 arcs, two 360 arcs with avoidance sectors around the contralateral parotid, two 260 or 270 arcs, and two 210 arcs. For bilateral neck irradiation, the volumetric-modulated arc therapy techniques included two 360 arcs, two 360 arcs with avoidance sectors around the shoulders, and 3 arcs. All patients had a sliding-window-delivery intensity modulated radiotherapy plan that was used as the benchmark for dosimetric comparison. For ipsilateral neck irradiation, a volumetric-modulated arc therapy technique using two 360 arcs with avoidance sectors around the contralateral parotid was dosimetrically comparable to intensity-modulated radiotherapy, with improved conformity (conformity index = 1.22 vs 1.36, p < 0.04) and lower contralateral parotid mean dose (5.6 vs 6.8 Gy, p < 0.03). For bilateral neck irradiation, 3-arc volumetric-modulated arc therapy techniques were dosimetrically comparable to intensity-modulated radiotherapy while also avoiding irradiation through the shoulders. All volumetric-modulated arc therapy techniques required fewer monitor units than sliding-window intensity-modulated radiotherapy to deliver treatment, with an average reduction of 35% for ipsilateral plans and 67% for bilateral plans. Thus, for ipsilateral head and neck irradiation a volumetric-modulated arc therapy technique using two 360 degrees arcs with avoidance sectors around the contralateral parotid is recommended. For bilateral neck irradiation, 2- or 3-arc techniques are dosimetrically comparable to intensity-modulated radiotherapy, but more work is needed to determine the optimal approaches by disease site. (C) 2017 American Association of Medical Dosimetrists.