title: Volumetric modulated arc radiotherapy for carcinomas of the oro-pharynx, hypo-pharynx and larynx: a treatment planning comparison with fixed field IMRT.
abstract: OBJECTIVE
  A planning study was performed to evaluate the performance of volumetric modulated arc radiotherapy on head and neck cancer patients. Conventional fixed field IMRT was used as a benchmark.
  
  
  METHODS
  CT datasets of 29 patients with squamous cell carcinoma of the oro-pharynx, hypo-pharynx and larynx were included. Plans for fixed beam IMRT, single (RA1) and double (RA2) modulated arcs with the RapidArc technique were optimised. Dose prescription was set to 66 Gy to the primary tumour (at 2.2 Gy/fraction), 60 Gy to intermediate-risk nodes and 54 Gy to low-risk nodal levels. The planning objectives for PTV were minimum dose >95%, and maximum dose <107%. Maximum dose to spinal cord was limited to 46 Gy, maximum to brain stem to 50 Gy. For parotids, mean dose <26 Gy (or median <30 Gy) was assumed as the objective. The MU and delivery time were scored to measure expected treatment efficiency.
  
  
  RESULTS
  Target coverage and homogeneity results improved with RA2 plans compared to both RA1 and IMRT. All the techniques fulfilled the objectives on maximum dose, while small deviations were observed on minimum dose for PTV. The conformity index (CI(95%)) was 1.7+/-0.2 for all the three techniques. RA2 allowed a reduction of D(2%) to spinal cord of approximately 3 Gy compared to IMRT (RA1 D(2%) increased it of approximately 1 Gy). On brain stem, D(2%) was reduced from 12 Gy (RA1 vs. IMRT) to 13.5 Gy (RA2 vs. IMRT). The mean dose to ipsi-lateral parotids was reduced from 40 Gy (IMRT) to 36.2 Gy (RA1) and 34.4 Gy (RA2). The mean dose to the contra-lateral gland ranged from 32.6 Gy (IMRT) to 30.9 Gy (RA1) and 28.2 Gy (RA2).
  
  
  CONCLUSIONS
  RapidArc was investigated for head and neck cancer. RA1 and RA2 showed some improvements in organs at risk and healthy tissue sparing, while only RA2 offered improved target coverage with respect to conventional IMRT.
authors.affiliation: Oncology Institute of Southern Switzerland, Radiation Oncology Department, Bellinzona, Switzerland.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Vanetti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Clivio
authors.forename: Giorgia
authors.initials: G
authors.lastname: Nicolini
authors.forename: Antonella
authors.initials: A
authors.lastname: Fogliata
authors.forename: Sarbani
authors.initials: S
authors.lastname: Ghosh-Laskar
authors.forename: Jai Prakash
authors.initials: JP
authors.lastname: Agarwal
authors.forename: Ritu Raj
authors.initials: RR
authors.lastname: Upreti
authors.forename: Ashwini
authors.initials: A
authors.lastname: Budrukkar
authors.forename: Vedang
authors.initials: V
authors.lastname: Murthy
authors.forename: Deepak Dattatray
authors.initials: DD
authors.lastname: Deshpande
authors.forename: Shyam Kishore
authors.initials: SK
authors.lastname: Shrivastava
authors.forename: Ketayun Ardeshir
authors.initials: KA
authors.lastname: Dinshaw
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D016896:Treatment Outcome