title: Volumetric modulated arc therapy (VMAT) vs. serial tomotherapy, step-and-shoot IMRT and 3D-conformal RT for treatment of prostate cancer.
abstract: BACKGROUND
  Volumetric modulated arc therapy (VMAT), a complex treatment strategy for intensity-modulated radiation therapy, may increase treatment efficiency and has recently been established clinically. This analysis compares VMAT against established IMRT and 3D-conformal radiation therapy (3D-CRT) delivery techniques.
  
  
  METHODS
  Based on CT datasets of 9 patients treated for prostate cancer step-and-shoot IMRT, serial tomotherapy (MIMiC), 3D-CRT and VMAT were compared with regard to plan quality and treatment efficiency. Two VMAT approaches (one rotation (VMAT1x) and one rotation plus a second 200 degrees rotation (VMAT2x)) were calculated for the plan comparison. Plan quality was assessed by calculating homogeneity and conformity index (HI and CI), dose to normal tissue (non-target) and D(95%) (dose encompassing 95% of the target volume). For plan efficiency evaluation, treatment time and number of monitor units (MU) were considered.
  
  
  RESULTS
  For MIMiC/IMRT(MLC)/VMAT2x/VMAT1x/3D-CRT, mean CI was 1.5/1.23/1.45/1.51/1.46 and HI was 1.19/1.1/1.09/1.11/1.04. For a prescribed dose of 76 Gy, mean doses to organs-at-risk (OAR) were 50.69 Gy/53.99 Gy/60.29 Gy/61.59 Gy/66.33 Gy for the anterior half of the rectum and 31.85 Gy/34.89 Gy/38.75 Gy/38.57 Gy/55.43 Gy for the posterior rectum. Volumes of non-target normal tissue receiving > or =70% of prescribed dose (53 Gy) were 337 ml/284 ml/482 ml/505 ml/414 ml, for > or =50% (38 Gy) 869 ml/933 ml/1155 ml/1231 ml/1993 ml and for > or =30% (23 Gy) 2819 ml/3414 ml/3340 ml/3438 ml /3061 ml. D(95%) was 69.79 Gy/70.51 Gy/71,7 Gy/71.59 Gy/73.42 Gy. Mean treatment time was 12 min/6 min/3.7 min/1.8 min/2.5 min.
  
  
  CONCLUSIONS
  All approaches yield treatment plans of improved quality when compared to 3D-conformal treatments, with serial tomotherapy providing best OAR sparing and VMAT being the most efficient treatment option in our comparison. Plans which were calculated with 3D-CRT provided good target coverage but resulted in higher dose to the rectum.
authors.affiliation: Department of Radiation Oncology of the University Medical Center Mannheim, University of Heidelberg, Germany. Wolff.dirk@gmx.de
authors.forename: Dirk
authors.initials: D
authors.lastname: Wolff
authors.forename: Florian
authors.initials: F
authors.lastname: Stieler
authors.forename: Grit
authors.initials: G
authors.lastname: Welzel
authors.forename: Friedlieb
authors.initials: F
authors.lastname: Lorenz
authors.forename: Yasser
authors.initials: Y
authors.lastname: Abo-Madyan
authors.forename: Sabine
authors.initials: S
authors.lastname: Mai
authors.forename: Carsten
authors.initials: C
authors.lastname: Herskind
authors.forename: Martin
authors.initials: M
authors.lastname: Polednik
authors.forename: Volker
authors.initials: V
authors.lastname: Steil
authors.forename: Frederik
authors.initials: F
authors.lastname: Wenz
authors.forename: Frank
authors.initials: F
authors.lastname: Lohr
mesh_terms: D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*