title: Comparison of four 3D conformal treatment techniques to optimise radiotherapy treatment for anal cancer.
abstract: BACKGROUND
  Chemoradiotherapy is the standard of care for anal cancer. Sizeable target volume leads to significant toxicity. We compared four different 3D conformal radiotherapy (3DCRT) techniques with the aim of finding the best technique to achieve the lowest dose to the organs at risk (OAR) without compromising the planning target volume (PTV) coverage.
  
  
  METHODS
  Fifteen computed tomography (CT) data sets from previously treated anal cancer patients (five male and 10 female) were re-contoured according to the Australasian Gastrointestinal Trials Group (AGITG) anal cancer contouring guidelines for N3 disease. Four different 3DCRT plans for each CT data set (standard, V-shape, diamond shape and alternate diamond shape) were generated. Comparisons of the radiation dose to non-rectal bowel (NRB), urinary bladder, genitalia, and femurs were performed.
  
  
  RESULTS
  V-shape technique achieved significantly lower NRB V40 (mean = 59.6% SD = 11%) than diamond (63.8% SD = 13%), standard (63.8% SD = 11%) and alternate diamond (63.6% SD = 12%) techniques. V-shape technique achieved the lowest mean bladder dose (mean = 45.3 Gy SD = 1.4 Gy). Diamond technique achieved the lowest femur V40 (mean = 32.4%)P< 0.001 for all comparisons between diamond and all other techniques. For genitalia V40, diamond technique (mean = 26.4% SD = 20%) and alternate diamond technique (mean = 27.6% SD = 20%) achieved significantly lower dose than V-shape technique (mean = 43.2% SD = 26%) and standard technique (mean = 76.1% SD = 16%)P< 0.001 for all comparisons.
  
  
  CONCLUSIONS
  Sophisticated 3DCRT techniques are superior to conventional techniques. Different 3DCRT techniques provide varying levels of dose reduction to OAR, with none of the four techniques investigated capable of reducing dose to all OAR. A combination of techniques may provide the best solution. Further refinement of these techniques should be explored.
authors.affiliation: Department of Radiation Therapy Services, Peter MacCallum Cancer Centre Box Hill, Victoria, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Cray
authors.affiliation: Department of Radiation Therapy Services, Peter MacCallum Cancer Centre Box Hill, Victoria, Australia.
authors.forename: Cathy
authors.initials: C
authors.lastname: Markham
authors.affiliation: Department of Radiation Therapy Services, Peter MacCallum Cancer Centre Box Hill, Victoria, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ryan
authors.affiliation: Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre Melbourne, Victoria, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Herschtal
authors.affiliation: Department of Radiation Oncology, Peter MacCallum Cancer Centre Melbourne, Victoria, Australia.
authors.forename: Samuel Y
authors.initials: SY
authors.lastname: Ngan
authors.affiliation: Department of Radiation Oncology, Peter MacCallum Cancer Centre Melbourne, Victoria, Australia.
authors.forename: Sarat
authors.initials: S
authors.lastname: Chander
keywords: Anal cancer; conformal radiotherapy; organ sparing treatments; organs at risk