title: Dosimetric study of volumetric arc modulation with RapidArc and intensity-modulated radiotherapy in patients with cervical cancer and comparison with 3-dimensional conformal technique for definitive radiotherapy in patients with cervical cancer.
abstract: For patients with cervical cancer, intensity-modulated radiation therapy (IMRT) improves target coverage and allows dose escalation while reducing the radiation dose to organs at risk (OARs). In this study, we compared dosimetric parameters among 3-dimensional conformal radiotherapy (3D-CRT), "step-and-shoot" IMRT, and volumetric intensity-modulated arc radiotherapy (VMAT) in a series of patients with cervical cancer receiving definitive radiotherapy. Computed tomography (CT) scans of 10 patients with histologically proven cervical cancer treated with definitive radiation therapy (RT) from December 2008 to March 2010 at our department were selected for this study. The gross tumor volume (GTV) and clinical target volume (CTV) were delineated following the guidelines of the Gyn IMRT consortium that included cervix, uterus, parametrial tissues, and the pelvic nodes including presacral. The median age was 57 years (range: 30 to 85 years). All 10 patients had squamous cell carcinoma with Federation of Gynecology and Obstetrics (FIGO) stage IB-IIIB. All patients were treated by VMAT. OAR doses were significantly reduced for plans with intensity-modulated technique compared with 3D-CRT except for the dose to the vagina. Between the 2 intensity-modulated techniques, significant difference was observed for the mean dose to the small intestine, to the benefit of VMAT (p < 0.001). There was no improvement in terms of OARs sparing for VMAT although there was a tendency for a slightly decreased average dose to the rectum: - 0.65Gy but not significant (p = 0.07). The intensity modulation techniques have many advantages in terms of quality indexes, and particularly OAR sparing, compared with 3D-CRT. Following the ongoing technologic developments in modern radiotherapy, it is essential to evaluate the intensity-modulated techniques on prospective studies of a larger scale.
authors.affiliation: Department of Radiation Oncology, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest en Jarez, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Guy
authors.affiliation: Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Falk
authors.affiliation: Department of Radiation Oncology, Clinique Claude Bernard, Albi, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Auberdiac
authors.affiliation: Department of Radiation Oncology, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest en Jarez, France.
authors.forename: Lysian
authors.initials: L
authors.lastname: Cartier
authors.affiliation: Department of Radiation Oncology, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest en Jarez, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Vallard
authors.affiliation: Department of Pharmacology-Toxicology, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Priest en Jarez, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Ollier
authors.affiliation: Department of Radiation Oncology, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest en Jarez, France.
authors.forename: Jane-Chloé
authors.initials: JC
authors.lastname: Trone
authors.affiliation: Department of Radiation Oncology, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest en Jarez, France.
authors.forename: Moustapha
authors.initials: M
authors.lastname: Khodri
authors.affiliation: Department of Radiation Oncology, Hôpital d'instruction de Armées du Val-de-Grâce, Paris, France.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Chargari
authors.affiliation: Department of Radiation Oncology, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest en Jarez, France. Electronic address: nicolas.magne@icloire.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Magné
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*
keywords: Cervical cancer; Dosimetry; IMRT; VMAT