Dosimetric comparison between IMRT and VMAT in irradiation for peripheral and central lung cancer

Yi Li, Ji Wang, Li Tan, Beina Hui, Xiaowei Ma, Yanli Yan, Chaofan Xue, Xiaoting Shi, Emmanuel Kwateng Drokow, Juan Ren, Yi Li, Ji Wang, Li Tan, Beina Hui, Xiaowei Ma, Yanli Yan, Chaofan Xue, Xiaoting Shi, Emmanuel Kwateng Drokow, Juan Ren

Abstract

The aim of the present study was to compare intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) in irradiation of lung cancer. Plans of 14 patients were compared. The results demonstrated that in peripheral lung cancer, V5 (%) of the lung in partial-arc (PA)-VMAT was decreased compared with IMRT, single-arc (SA)-, and double partial-arc (2PA)-VMAT. V30 (%) of the lung in IMRT was decreased compared with SA-, PA- and 2PA-VMAT. In the case of planning target volume (PTV) not encompassing the mediastinum in central lung cancer, the conformality index (CI) and heterogeneity index (HI) of SA-VMAT was improved compared with IMRT, PA-, and 2PA-VMAT. The received dose of heart in SA-VMAT was higher compared with IMRT, PA- and 2PA-VMAT. V30 (%) and V5 (%) of the lung in IMRT was higher compared with SA-, PA- and 2PA-VMAT; V10 (%) of the lung in 2PA was decreased compared with IMRT, SA- and PA. In the case of PTV encompassing the mediastinum in central lung cancer, the HI and CI of 2PA was improved compared with IMRT, SA- and PA-VMAT. The received dose of heart in 2PA was higher compared with IMRT, SA- and PA-VMAT. V30 (%) and V5 (%) of the lung in 2PA-VMAT was higher compared with IMRT, SA- and PA-VMAT. V20 (%) of the lung in 2PA was decreased compared with IMRT, SA- and PA-VMAT. In conclusion, it may be necessary to classify the radiotherapy plans of lung cancer into three categories including peripheral lung cancer, PTV not encompassing the mediastinum of central lung cancer, and PTV encompassing the mediastinum of central lung cancer. Each of IMRT, SA-VMAT, PA-VMAT, 2PA-VMAT strategy had individual advantages, and therefore it may be crucial to employ different planning techniques for different disease classifications and OAR requirements.

Keywords: central lung cancer; dosimetry; intensity-modulated radiation therapy; peripheral lung cancer; volumetric modulated arc therapy.

Figures

Figure 1.
Figure 1.
Isodose curves of IMRT plan and 2PA-VMAT plan in peripheral lung cancer. (A) Isodose curves of IMRT plan. (B) Isodose curves of SA-VMAT plan. (C) Isodose curves of PA-VMAT plan. (D) Isodose curves of 2PA-VMAT plan. In peripheral lung cancer, both IMRT plan and VMAT plan exhibited satisfying prescribed tumor target coverage and OAR sparing. However, 2PA-VMAT displayed improved PTV coverage compared with IMRT. 2PA-VMAT exhibited better sparing of spinal cord, lung-all, and lung-contralateral compared with IMRT, while IMRT exhibited better heart and lung-ipsilateral sparing compared with 2PA-VMAT. IMRT had better dose conformity and homogeneity. IMRT, intensity-modulated radiation therapy; VMAT, volumetric modulated arc therapy; 2PA, double partial arc; PA, partial arc; SA, single arc; OAR, organs-at-risk.
Figure 2.
Figure 2.
Line charts display the comparison of (A) CI and (B) HI between VMAT and IMRT plans in 6 patients (indicated by different lines) with peripheral lung cancer. The horizontal axis represents the four different plans. The vertical axis represents values of CI and HI. CI, conformity index; HI, homogeneity index; VMAT, volumetric modulated arc therapy; IMRT, intensity-modulated radiation therapy; PA, partial arc; SA, single arc; 2PA, double partial arc.
Figure 3.
Figure 3.
Line charts display the comparison of different dosimetric parameters (indicated by different lines) between VMAT and IMRT plans in 6 patients (indicated by A-a-F-f) with peripheral lung cancer. The horizontal axis represents the four different plans. The vertical axis represents the dose size. For each case, the capital letters show the unit for dose size in cGy, and the small letters show the unit for dose size in %. VMAT, volumetric modulated arc therapy; IMRT, intensity-modulated radiation therapy; cGy, centigray; PA, partial arc; SA, single arc; 2PA, double partial arc.
Figure 4.
Figure 4.
Isodose curves of 2PA-VMAT and IMRT plans in central lung cancer in which the target volume does not encompass the mediastinal lymphatic drainage region. (A) Isodose curves of IMRT plan. (B) Isodose curves of SA-VMAT plan. (C) Isodose curves of PA-VMAT plan. (D) Isodose curves of 2PA-VMAT plan. In central lung cancer, when PTV does not encompass the mediastinum, there was no significant difference in PTV coverage between the IMRT and 2PA-VMAT plans. 2PA-VMAT exhibited better spinal cord sparing, and better dose conformity and homogeneity. 2PA, double partial arc; VMAT, volumetric modulated arc therapy; IMRT, intensity-modulated radiation therapy; PA, partial arc; SA, single arc; PTV, planning target volume.
Figure 5.
Figure 5.
Line charts display the comparison of (A) CI and (B) HI between VMAT and IMRT plans in 4 patients with central lung cancer in which the target volume encompasses the mediastinal lymphatic drainage region. The horizontal axis represents the four different plans. The vertical axis represents values of CI and HI. CI, conformity index; HI, homogeneity index; VMAT, volumetric modulated arc therapy; IMRT, intensity-modulated radiation therapy; PA, partial arc; SA, single arc; 2PA, double partial arc.
Figure 6.
Figure 6.
Line charts display the comparison of different dosimetric parameters (indicated by different lines) between VMAT and IMRT plans in 4 patients (indicated by A-a-D-d,) with central lung cancer in which the target volume encompasses the mediastinal lymphatic drainage region. The horizontal axis represents the four different plans. The vertical axis represents dose size. In each case, the capital letters show the unit for dose size in cGy, and the small letters show the unit for dose size in %. VMAT, volumetric modulated arc therapy; IMRT, intensity-modulated radiation therapy; cGy, centigray; PA, partial arc; SA, single arc; 2PA, double partial arc.
Figure 7.
Figure 7.
Isodose curves of 2PA-VMAT and IMRT plans in central lung cancer in which the target volume encompasses the mediastinal lymphatic drainage region. (A) Isodose curves of IMRT plan. (B) Isodose curves of SA-VMAT plan. (C) Isodose curves of PA-VMAT plan. (D) Isodose curves of 2PA-VMAT plan. In central lung cancer, when PTV encompasses the mediastinum, 2PA-VMAT exhibited improved PTV coverage compared with IMRT. IMRT exhibited better sparing of spinal cord, lung-all, lung-ipsilateral, and lung-contralateral compared with 2PA-VMAT. In addition, IMRT exhibited better dose conformity and homogeneity. 2PA, double partial arc; VMAT, volumetric modulated arc therapy; IMRT, intensity-modulated radiation therapy; PA, partial arc; SA, single arc; PTV, planning target volume.
Figure 8.
Figure 8.
Line charts display the comparison of (A) CI and (B) HI between VMAT and IMRT plans in 4 patients (indicated by different lines) with central lung cancer in which the target volume does not encompass the mediastinal lymphatic drainage region. The horizontal axis represents the four different plans. The vertical axis represents values of CI and HI. CI, conformity index; HI, homogeneity index; VMAT, volumetric modulated arc therapy; IMRT, intensity-modulated radiation therapy; PA, partial arc; SA, single arc; 2PA, double partial arc.
Figure 9.
Figure 9.
Line charts display the comparison of different dosimetric parameters (indicated by different lines) between VMAT and IMRT plans in 4 patients (indicated by Aa-Dd) with central lung cancer in which the target volume does not encompass the mediastinal lymphatic drainage region. The horizontal axis represents the four different plans. The vertical axis represents dose size. In each case, the capital letters show the unit for dose size in cGy, and the small letters show the unit for dose size in %. VMAT, volumetric modulated arc therapy; IMRT, intensity-modulated radiation therapy; cGy, centigray; PA, partial arc; SA, single arc; 2PA, double partial arc.

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