Dosimetric comparison between jaw tracking and static jaw techniques in intensity-modulated radiotherapy

To compare the dosimetric differences between jaw tracking technique (JTT) and static jaw technique (SJT) in dynamic intensity-modulated radiotherapy (d-IMRT) and assess the potential advantages of jaw tracking technique.

Two techniques, jaw tracking and static jaw, were used respectively to develop the d-IMRT plans for 28 cancer patients with various lesion sites: head and neck, lungs, esophageal, abdominal, prostate, rectal and cervical. The dose volume histograms (DVH) and selected dosimetric indexes for the whole body and for organs at risk (OARs) were compared. A two dimensional ionization chamber Array Seven29 (PTW, Freiburg, Germany) and OCTAVIUS Octagonal phantom (PTW, Freiburg, Germany) were used to verify all the plans.

For all patients, the treatment plans using both techniques met the clinical requirements. The V₅, V₁₀, V₂₀, V₃₀, V₄₀ (volumes receiving 5, 10, 20, 30 and 40 Gy at least, respectively), mean dose (D_mean) for the whole body and V₅, V₁₀, V₂₀, D_mean for lungs in the JTT d-IMRT plans were significantly less than the corresponding values of the SJT d-IMRT plans (p < 0.001). The JTT d-IMRT plans deposited lower maximum dose (D_max) to the lens, eyes, brainstem, spinal cord, and right optic nerve, the doses reductions for these OARs ranged from 2.2% to 28.6%. The JTT d-IMRT plans deposited significantly lower D_mean to various OARs (all p values < 0.05), the mean doses reductions for these OARs ranged from 1.1% to 31.0%, and the value reductions depend on the volume and the location of the OARs. The γ evaluation method showed an excellent agreement between calculation and measurement for all techniques with criteria of 3%/3 mm.

Both jaw tracking and static jaw d-IMRT plans can achieve comparable target dose coverage. JTT displays superior OARs sparing than SJT plans. These results are of clinical importance, especially for the patients with large and complex targets but close to some highly radio-sensitive organs to spare, and for patients with local recurrent or secondary primary malignant lesion within a previously irradiated area.