title: Feasibility of constant dose rate VMAT in the treatment of nasopharyngeal cancer patients.
abstract: OBJECTIVE
  To investigate the feasibility of constant dose rate volumetric modulated arc therapy (CDR-VMAT) in the treatment of nasopharyngeal cancer (NPC) patients and to introduce rotational arc radiotherapy for linacs incapable of dose rate variation.
  
  
  METHODS
  Twelve NPC patients with various stages treated previously using variable dose rate (VDR) VMAT were enrolled in this study. CDR-VMAT, VDR-VMAT and mutlicriteria optimization (MCO) VMAT plans were generated for each patient on RayStation treatment planning system with identical objective functions and the dosimetric differences among these three planning schemes were evaluated and compared. Non dosimetric parameters of optimization time, delivery time and delivery accuracy were also evaluated.
  
  
  RESULTS
  The planning target volume of clinical target volume (PTV-CTV) coverage of CDR-VMAT was a bit inferior to those of VDR- and MCO-VMAT. The V93 (p=0.01) and V95 (percent volume covered by isodose line) (p=0.04) for CDR-VMAT, VDR-VMAT and MCO-VMAT were 98.74% ± 0.31%, 99.76% ± 0.16%, 99.38% ± 0.43%, and 98.40% ± 0.48%, 99.53% ± 0.28%, 99.07% ±0.52%, respectively. However, the CDR-VMAT showed a better dose homogeneity index (HI) (p=0.01) in PTV-CTV. No significant difference in other target coverage parameters was observed. There was no significant difference in OAR sparing among these three planning schemes except for a higher maximum dose (Dmax) on the brainstem for CDR-VMAT. The brainstem Dmax of CDR-VMAT, VDR-VMAT and MCO-VMAT were 54.26 ± 3.21 Gy, 52.19 ± 1.65 Gy, and 52.79 ± 4.77 Gy, respectively. The average delivery time (p<0.01) and the average percent γ passing rates (p=0.02) of CDR-VMAT, VDR-VMAT and MCO-VMAT were 7.01 ± 0.43 min, 4.75 ± 0.07 min, 4.01 ± 0.28 min, and 95.75% ± 2.57%, 97.65% ± 1.45%, 97.36% ± 2.45%, respectively.
  
  
  CONCLUSIONS
  CDR-VMAT offers an additional option of rotational arc radiotherapy for linacs incapable of dose rate variation with a lower initial cost. Its plan quality was acceptable but should be thoroughly checked compared with VDR-VMAT and MCO-VMAT in the treatment of NPC.
authors.affiliation: Radiation Oncology Department, Quzhou People's Hospital, No. 2 Zhongloudi Street, Quzhou, 324000, China. wlyu1982@aliyun.com.
authors.forename: Wenliang
authors.initials: W
authors.lastname: Yu
authors.affiliation: Research department of IPTA(Beijing) Investment Administration Co., Ltd, Beijing, China. shanghaijiao@ipta-med.com.
authors.forename: Haijiao
authors.initials: H
authors.lastname: Shang
authors.affiliation: Department of Radiotherapy and Chemotherapy, the 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China. billy07@wzhospital.cn.
authors.forename: Congying
authors.initials: C
authors.lastname: Xie
authors.affiliation: Department of Radiotherapy and Chemotherapy, the 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China. han_ce06@163.com.
authors.forename: Ce
authors.initials: C
authors.lastname: Han
authors.affiliation: Department of Radiotherapy and Chemotherapy, the 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China. ylj6695@sina.com.
authors.forename: Jinling
authors.initials: J
authors.lastname: Yi
authors.affiliation: Department of Radiotherapy and Chemotherapy, the 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China. zhouyongqiang1980@163.com.
authors.forename: Yongqiang
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Radiotherapy and Chemotherapy, the 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China. physics@wzhospital.cn.
authors.forename: Xiance
authors.initials: X
authors.lastname: Jin
mesh_terms: D000368:Aged; D002277:Carcinoma; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D058958:Organs at Risk / Q000528:radiation effects*; D010315:Particle Accelerators; D011379:Prognosis; D011874:Radiometry / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*