Volumetric intensity-modulated arc therapy vs. conventional IMRT in head-and-neck cancer: a comparative planning and dosimetric study.
OBJECTIVE
Volumetric intensity-modulated arc therapy (RA) allows for rapid delivery of highly conformal dose distributions. In this study, planning and dosimetry of RA were compared with conventional intensity-modulated radiation therapy (IMRT) plans of head-and-neck cancer patients.


METHODS
Computed tomography scans of 12 patients who had completed IMRT for advanced tumors of the naso-, oro- and hypopharynx were replanned using RA using either one or two arcs. Calculated doses to planning target volume (PTV) and organs at risk (OAR) were compared between IMRT and RA plans. Dose distributions for single arc (n = 8) and double arc (n = 4) plans were verified using film dosimetry in three to five coronal planes using a quality assurance phantom.


RESULTS
RA plans allowed for a mean reduction in number of monitor units (MU) by nearly 60%, relative to seven field sliding window IMRT plans. RA plans achieved similar sparing of all OAR as IMRT. Double arc RA provided the best dose homogeneity to PTV with a lower standard deviation of PTV dose (1.4 Gy), vs. single arc plans (2.0 Gy) and IMRT (1.7 Gy). Film measurements showed good correspondence with calculated doses; the mean gamma value was 0.30 (double arc) and area of the film with a gamma exceeding 1 was 0.82%.


CONCLUSIONS
RA is a fast, safe, and accurate technique that uses lower MUs than conventional IMRT. Double arc plans provided at least similar sparing of OAR and better PTV dose homogeneity than single arc or IMRT.
Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Wilko F A R
WF
Verbakel
Johan P
JP
Cuijpers
Daan
D
Hoffmans
Michael
M
Bieker
Ben J
BJ
Slotman
Suresh
S
Senan
D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D015182:Lymphatic Irradiation; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D047368:Tumor Burden