title: 3D-Conformal versus intensity-modulated postoperative radiotherapy of vaginal vault: A dosimetric comparison.
abstract: We evaluated a step-and-shoot IMRT plan in the postoperative irradiation of the vaginal vault compared with equispaced beam arrangements (3-5) 3D-radiotherapy (RT) optimized plans. Twelve patients were included in this analysis. Four plans for each patient were compared in terms of dose-volume histograms, homogeneity index (HI), and conformity index (CI): (1) 3 equispaced beam arrangement 3D-RT; (2) 4 equispaced beam arrangement 3D-RT; (3) 5 equispaced beam arrangement 3D-RT; (4) step-and-shoot IMRT technique. CI showed a good discrimination between the four plans. The mean scores of CI were 0.58 (range: 0.38-0.67) for the 3F-CRT plan, 0.58 (range: 0.41-0.66) for 4F-CRT, 0.62 (range: 0.43-0.68) for 5F-CRT and 0.69 (range: 0.58-0.78) for the IMRT plan. A significant improvement of the conformity was reached by the IMRT plan (p < 0.001 for all comparisons). As expected, the increment of 3D-CRT fields was associated with an improvement of target dose conformity and homogeneity; on the contrary, in the IMRT plans, a better conformity was associated to a worse target dose homogeneity. A significant reduction in terms of D(mean), V90%, V95%, V100% was recorded for rectal and bladder irradiation with the IMRT plan. Surprisingly, IMRT supplied a significant dose reduction also for rectum and bladder V30% and V50%. A significant dosimetric advantage of IMRT over 3D-RT in the adjuvant treatment of vaginal vault alone in terms of treatment conformity and rectum and bladder sparing is shown.
authors.affiliation: Department of Oncology, "John Paul II" Center for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso, Italy.
authors.forename: Savino
authors.initials: S
authors.lastname: Cilla
authors.forename: Gabriella
authors.initials: G
authors.lastname: Macchia
authors.forename: Cinzia
authors.initials: C
authors.lastname: Digesù
authors.forename: Francesco
authors.initials: F
authors.lastname: Deodato
authors.forename: Michele
authors.initials: M
authors.lastname: Romanella
authors.forename: Gabriella
authors.initials: G
authors.lastname: Ferrandina
authors.forename: Gilbert D A
authors.initials: GD
authors.lastname: Padula
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Picardi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.forename: Angelo
authors.initials: A
authors.lastname: Piermattei
authors.forename: Alessio Giuseppe
authors.initials: AG
authors.lastname: Morganti
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D011874:Radiometry; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated; D016896:Treatment Outcome