title: Volume Modulated Arc Therapy (VMAT) for pulmonary Stereotactic Body Radiotherapy (SBRT) in patients with lesions in close approximation to the chest wall.
abstract: OBJECTIVE
  Chest wall pain and discomfort has been recognized as a significant late effect of radiation therapy in historical and modern treatment models. Stereotactic Body Radiotherapy (SBRT) is becoming an important treatment tool in oncology care for patients with intrathoracic lesions. For lesions in close approximation to the chest wall with motion management, SBRT techniques can deliver high dose to the chest wall. As an unintended target of consequence, there is possibility of imposing significant chest wall pain and discomfort as a late effect of therapy. The purpose of this paper is to evaluate the potential role of Volume Modulated Arc Therapy (VMAT) technologies in decreasing chest wall dose in SBRT treatment of pulmonary lesions in close approximation to the chest wall.
  
  
  METHODS
  Ten patients with pulmonary lesions of various sizes and tomography in close approximation to the chest wall were selected for retrospective review. All volumes including tumor target, chest wall, ribs, and lung were contoured with maximal intensity projection maps and four-dimensional computer tomography planning. Radiation therapy planning consisted of static techniques including Intensity Modulated Radiation Therapy compared to VMAT therapy to a dose of 60 Gy in 12 Gy fraction dose. Dose volume histogram to rib, chest wall, and lung were compared between plans with statistical analysis.
  
  
  RESULTS
  In all patients, dose and volume were improved to ribs and chest wall using VMAT technologies compared to static field techniques. On average, volume receiving 30 Gy to the chest wall was improved by 74%; the ribs by 60%. In only one patient did the VMAT treatment technique increase pulmonary volume receiving 20 Gy (V20).
  
  
  CONCLUSIONS
  VMAT technology has potential of limiting radiation dose to sensitive chest wall regions in patients with lesions in close approximation to this structure. This would also have potential value to lesions treated with SBRT in other body regions where targets abut critical structures.
authors: Department of Radiation Oncology, University of Massachusetts Medical School and the University of Massachusetts Memorial Health Care System Worcester, MA, USA.
authors: Linda
authors: L
authors: Ding
authors: Yuan-Chyuan
authors: YC
authors: Lo
authors: Sidney
authors: S
authors: Kadish
authors: David
authors: D
authors: Goff
authors: Richard S
authors: RS
authors: Pieters
authors: Geoffrey
authors: G
authors: Graeber
authors: Karl
authors: K
authors: Uy
authors: Syed
authors: S
authors: Quadri
authors: Richard
authors: R
authors: Moser
authors: Kevin
authors: K
authors: Martin
authors: John
authors: J
authors: Day
authors: Thomas J
authors: TJ
authors: Fitzgerald
keywords: Volume Modulated Arc Therapy; chest wall; intrathoracic lesions; radiation therapy; stereotactic body radiotherapy