title: RapidArc, SmartArc and TomoHD compared with classical step and shoot and sliding window intensity modulated radiotherapy in an oropharyngeal cancer treatment plan comparison.
abstract: BACKGROUND
  Radiotherapy techniques have evolved rapidly over the last decade with the introduction of Intensity Modulated RadioTherapy (IMRT) in different forms. It is not clear which of the IMRT techniques is superior in the treatment of head and neck cancer patients in terms of coverage of the planning target volumes (PTVs), sparing the organs at risk (OARs), dose to the normal tissue, number of monitor units needed and delivery time.The present paper aims to compare Step and Shoot (SS) IMRT, Sliding Window (SW) IMRT, RapidArc (RA) planned with Eclipse, Elekta VMAT planned with SmartArc (SA) and helical TomoHD™ (HT).
  
  
  METHODS
  Target volumes and organs at risk (OARs) of five patients with oropharyngeal cancer were delineated on contrast enhanced CT-scans, then treatment plans were generated on five different IMRT systems. In 32 fractions, 69.12 Gy and 56 Gy were planned to the therapeutic and prophylactic PTVs, respectively. For the PTVs and 26 OARs ICRU 83 reporting guidelines were followed. Differences in the studied parameters between treatment planning systems were analysed using repeated measures ANOVA.
  
  
  RESULTS
  Mean Homogeneity Index of PTV(therapeutic) is better with HT(.06) followed by SA(.08), RA(.10), SW(.10) and SS(.11). PTV(prophylactic) is most homogeneous with RA. Parotid glands prescribed mean doses are only obtained by SA and HT, 20.6 Gy and 21.7 Gy for the contralateral and 25.6 Gy and 24.1 Gy for the ipsilateral, against 25.6 Gy and 32.0 Gy for RA, 26.4 Gy and 34.6 Gy for SW, and 28.2 Gy and 34.0 Gy for SS. RA uses the least monitor units, HT the most. Treatment times are 3.05 min for RA, and 5.9 min for SA and HT.
  
  
  CONCLUSIONS
  In the treatment of oropharyngeal cancer, we consider rotational IMRT techniques preferable to fixed gantry techniques due to faster fraction delivery and better sparing of OARs without a higher integral dose. TomoHD gives most homogeneous target coverage with more sparing of spinal cord, brainstem, parotids and the lower swallowing apparatus than most of the other systems. Between RA and SA, SA gives a more homogeneous PTV(therapeutic) while sparing the parotids more, but the delivery of RA is twice as fast with less overdose to the PTV(elective).
authors: Department of Radiotherapy, University Radiotherapy department Antwerp - UZA / ZNA, Lindendreef 1, 2020 Antwerp, Belgium. dirk.vangestel@zna.be
authors: Dirk
authors: D
authors: Van Gestel
authors: Corine
authors: C
authors: van Vliet-Vroegindeweij
authors: Frank
authors: F
authors: Van den Heuvel
authors: Wouter
authors: W
authors: Crijns
authors: Ann
authors: A
authors: Coelmont
authors: Bie
authors: B
authors: De Ost
authors: Andrea
authors: A
authors: Holt
authors: Emmy
authors: E
authors: Lamers
authors: Yasmyne
authors: Y
authors: Geussens
authors: Sandra
authors: S
authors: Nuyts
authors: Danielle
authors: D
authors: Van den Weyngaert
authors: Tim
authors: T
authors: Van den Wyngaert
authors: Jan B
authors: JB
authors: Vermorken
authors: Vincent
authors: V
authors: Gregoire
mesh_terms: D006801:Humans; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D047368:Tumor Burden