title: Volumetric modulation arc radiotherapy compared with static gantry intensity-modulated radiotherapy for malignant pleural mesothelioma tumor: a feasibility study.
abstract: OBJECTIVE
  A planning study was performed to evaluate RapidArc (RA), a volumetric modulated arc technique, on malignant pleural mesothelioma. The benchmark was conventional fixed-field intensity-modulated radiotherapy (IMRT).
  
  
  METHODS
  The computed tomography data sets of 6 patients were included. The plans for IMRT with nine fixed beams were compared against double-modulated arcs with a single isocenter. All plans were optimized for 15-MV photon beams. The dose prescription was 54 Gy to the planning target volume. The planning objectives for the planning target volume were a minimal dose of >95% and maximal dose of <107%. For the organs at risk, the parameters were as follows: contralateral lung, percentage of volume receiving 5 Gy (V(5 Gy)) <60%, V(20 Gy) < 10%, mean <10.0 Gy; liver, V(30 Gy) <33%, mean <31 Gy; heart, V(45 Gy) <30%, V(50 Gy) <20%, dose received by 1% of the volume (D(1%)) <60 Gy; contralateral kidney, V(15 Gy) <20%; spine, D(1%) <45 Gy; esophagus, V(55 Gy) <30%; and spleen, V(40 Gy) <50%. The monitor units (MUs) and delivery time were scored to measure the treatment efficiency. The pretreatment portal dosimetry scored delivery to the calculation agreement with the Gamma Agreement Index.
  
  
  RESULTS
  RA and IMRT provided equivalent coverage and homogeneity. Both techniques fulfilled objectives on organs at risk with a tendency of RA to improve sparing. The conformity index was 1.9 +/- 0.1 for RA and IMRT. The number of MU/2 Gy was 734 +/- 82 for RA and 2,195 +/- 317 for IMRT. The planning vs. delivery agreement revealed a Gamma Agreement Index for IMRT of 96.0% +/- 2.6% and for RA of 95.7% +/- 1.5%. The treatment time was 3.7 +/- 0.3 min for RA and 13.4 +/- 0.1 min for IMRT.
  
  
  CONCLUSIONS
  RA demonstrated compared with conventional IMRT, similar target coverage and better dose sparing to the organs at risks. The number of MUs and the time required to deliver a 2-Gy fraction were much lower for RA, allowing the possibility to incorporate this technique in the treatment options for mesothelioma patients.
authors.affiliation: Department of Radiation Oncology, Istituto Clinico Humanitas, Rozzano, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
authors.forename: Mario
authors.initials: M
authors.lastname: Bignardi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Clivio
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
authors.forename: Antonella
authors.initials: A
authors.lastname: Fogliata
authors.forename: Paola
authors.initials: P
authors.lastname: Lattuada
authors.forename: Pietro
authors.initials: P
authors.lastname: Mancosu
authors.forename: Piera
authors.initials: P
authors.lastname: Navarria
authors.forename: Giorgia
authors.initials: G
authors.lastname: Nicolini
authors.forename: Gaetano
authors.initials: G
authors.lastname: Urso
authors.forename: Eugenio
authors.initials: E
authors.lastname: Vanetti
authors.forename: Sabrina
authors.initials: S
authors.lastname: Vigorito
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
mesh_terms: D004947:Esophagus; D005240:Feasibility Studies; D006321:Heart / Q000528:radiation effects; D006801:Humans; D007668:Kidney / Q000528:radiation effects; D008099:Liver / Q000528:radiation effects; D008168:Lung / Q000528:radiation effects; D008654:Mesothelioma / Q000532:radiotherapy*; D017785:Photons / Q000627:therapeutic use; D010997:Pleural Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000517:prevention & control; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D013154:Spleen / Q000528:radiation effects