title: Volumetric modulated arc therapy planning for distal oesophageal malignancies.
abstract: OBJECTIVE
  Volumetric modulated arc therapy (VMAT) is a novel form of intensity-modulated radiation therapy that allows the radiation dose to be delivered in a single gantry rotation using conformal or modulated fields. The capability of VMAT to reduce heart and cord dose, while maintaining lung receiving 20 Gy <20%, was evaluated for chemoradiation for oesophageal cancer.
  
  
  METHODS
  An optimised forward-planned four-field arrangement was compared with inverse-planned coplanar VMAT arcs with 35 control points for 10 patients with lower gastro-oesophageal tumours prescribed 54 Gy in 30 fractions. Conformal (cARC) and intensity-modulated (VMATi) arcs were considered. Plans were assessed and compared using the planning target volume (PTV) irradiated to 95% of the prescription dose (V95), volumes of lung irradiated to 20 Gy (V20), heart irradiated to 30 Gy (V30), spinal cord maximum dose and van't Riet conformation number (CN). The monitor units per fraction and delivery time were recorded for a single representative plan.
  
  
  RESULTS
  VMATi provided a significant reduction in the heart V30 (31% vs 55%; p=0.02) with better CN (0.72 vs 0.65; p=0.01) than the conformal plan. The treatment delivery was 1 min 28 s for VMAT compared with 3 min 15 s.
  
  
  CONCLUSIONS
  For similar PTV coverage, VMATi delivers a lower dose to organs at risk than conformal plans in a shorter time, and this has warranted clinical implementation.
authors.affiliation: Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, Sutton, UK. maria.hawkins@rmh.nhs.uk
authors.forename: M A
authors.initials: MA
authors.lastname: Hawkins
authors.forename: J L
authors.initials: JL
authors.lastname: Bedford
authors.forename: A P
authors.initials: AP
authors.lastname: Warrington
authors.forename: D M
authors.initials: DM
authors.lastname: Tait
mesh_terms: D004938:Esophageal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006321:Heart / Q000528:radiation effects; D006801:Humans; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D013116:Spinal Cord / Q000528:radiation effects