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Radiation Oncology

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Open Access 01-12-2014 | Research

A treatment planning study comparing Elekta VMAT and fixed field IMRT using the varian treatment planning system eclipse

Authors: Samuel Peters, Hans Schiefer, Ludwig Plasswilm

Published in: Radiation Oncology | Issue 1/2014

Abstract

Background

The newest release of the Eclipse (Varian) treatment planning system (TPS) includes an optimizing engine for Elekta volumetric-modulated arc therapy (VMAT) planning. The purpose of this study was to evaluate this new algorithm and to compare it to intensity-modulated radiation therapy (IMRT) for various disease sites by creating single- and double-arc VMAT plans.

Methods

A total of 162 plans were evaluated in this study, including 38 endometrial, 57 head and neck, 12 brain, 10 breast and 45 prostate cancer cases. The real-life IMRT plans were developed during routine clinical cases using the TPS Eclipse. VMAT plans were generated using a preclinical version of Eclipse with tumor-region-specific optimizing templates without interference of the operator: with one full arc (1A) and with two full arcs (2A), and with partial arcs for breast and prostate with hip implant cases. All plans were evaluated based on target coverage, homogeneity and conformity. The organs at risk (OARs) were analyzed according to plan objectives, such as the mean and maximum doses. If one or more objectives were exceeded, the plan was considered clinically unacceptable, and a second VMAT plan was created by adapting the optimization penalties once.

Results

Compared to IMRT, single- and double-arc VMAT plans showed comparable or better results concerning the target coverage: the maximum dose in the target for 1A is the same as that for IMRT; for 2A, an average reduction of 1.3% over all plans was observed. The conformity showed a statistically significant improvement for both 1A (+3%) and 2A (+6%). The mean total body dose was statistically significant lower for the considered arc techniques (IMRT: 16.0 Gy, VMAT: 15.3 Gy, p < 0.001). However, the sparing of OARs shows individual behavior that depends strongly on the different tumor regions. A clear difference is found in the number of monitor units (MUs) per plan: VMAT shows a reduction of 31%.

Conclusion

These findings demonstrate that based on optimizing templates with minimal interaction of the operator, the Eclipse TPS is able to achieve a plan quality for the Elekta VMAT delivery technique that is comparable to that of fixed-field IMRT. Plans with two arcs show better dose distributions than plans with one arc.

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Otto K: Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys 2008, 35: 310-317. 10.1118/1.2818738CrossRefPubMed

Yu CX: Intensity-modulated arc therapy with dynamic multileaf collimation: an alternative to tomotherapy. Phys Med Biol 1995, 40: 1435-1449. 10.1088/0031-9155/40/9/004CrossRefPubMed

Wong E, Chen JZ, Greenland J: Intensity-modulated arc therapy simplified. Int J Radiat Oncol Biol Phys 2002, 51: 222-235.CrossRef

Yu CX, Li XA, Ma L, Naqvi S, Shepard D, Sarfaraz M, Holmes TW, Suntharalingam M, Mansfield CM: Clinical implementation of intensity-modulated arc therapy. Int J Radiat Oncol Biol Phys 2002, 53: 453-463. 10.1016/S0360-3016(02)02777-3CrossRefPubMed

Pirzkall A, Carol M, Lohr F, Höss A, Wannenmacher M, Debus J: Comparison of intensity-modulated radiotherapy with conventional conformal radiotherapy for complexshaped tumors. Int J Radiat Oncol Biol Phys 2000, 48: 1371-1380. 10.1016/S0360-3016(00)00772-0CrossRefPubMed

Ramsey CR, Spencer KM, Alhakeem R, Oliver AL: Leaf position error during conformal dynamic arc and intensity modulated arc treatments. Med Phys 2001, 28: 67-72. 10.1118/1.1333410CrossRefPubMed

Shepard DM, Cao D, Afghan KMN, Earl MA: An arc-sequencing algorithm for intensity modulated arc therapy. Med Phys 2007, 34: 464-470. 10.1118/1.2409239CrossRefPubMed

Earl MA, Shepard DM, Naqvi S, Li XA, Yu CX: Inverse planning for intensity-modulated arc therapy using direct aperture optimization. Phys Med Biol 2003, 48: 1075-1089. 10.1088/0031-9155/48/8/309CrossRefPubMed

Bzduseka K, Friberger H, Eriksson K, Hårdemark B, Robinson D, Kaus M: Development and evaluation of an efficient approach to volumetric arc therapy planning. Med Phys 2009, 36: 2328-2339. 10.1118/1.3132234CrossRef

10.

Rao M, Yang W, Chen F, Cheng K, Ye J, Mehta V, Shepard D, Cao D: Comparison of Elekta VMAT with helical tomotherapy and fixed field IMRT: pan quality, delivery efficiency and accuracy. Med Phys 2010, 37: 1350-1359. 10.1118/1.3326965CrossRefPubMed

11.

Cozzi L, Dinshaw KA, Shrivastava SK, Mahantshetty U, Engineer R, Deshpande DD, Jamema SV, Vanetti E, Clivio A, Nicolini G, Fogliata A: A treatment planning study comparing volumetric arc modulation with RapidArc and fixed field IMRT for cervix uteri radiotherapy. Radiother Oncol 2008, 89: 180-191. 10.1016/j.radonc.2008.06.013CrossRefPubMed

12.

Chow J, Jiang R: Prostate volumetric-modulated arc therapy: dosimetry and radiobiological model variation between the single-arc and double-arc technique. J Appl Clin Med Phys 2013, 14: 3-12.

13.

Lee T, Chao P, Ting H, Lo S, Wang Y, Tuan C, Fang F, Su T: Comparative analysis of SmartArc-based dual arc volumetric-modulated arc radiotherapy (VMAT) versus intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma. J Appl Clin Med Phys 2011, 12: 158-174.

14.

Panet-Raymond V, Ansbacher W, Zavgorodni S, Bendorffe B, Nichol A, Truong PT, Beckham W, Vlachaki M: Coplanar versus noncoplanar intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) treatment planning for fronto-temporal high-grade glioma. J Appl Clin Med Phys 2012, 13: 44-53.

15.

Krayenbuehl J, Riesterer O, Graydon S, Dimmerling P, Kloeck S, Ciernik I: Intensity-modulated radiotherapy and volumetric-modulated arc therapy for malignant pleural mesothelioma after extrapleural pleuropneumonectomy. J Appl Clin Med Phys 2013, 14: 1-10.

16.

Vanetti E, Clivio A, Nicolini G, Fogliata A, Ghosh-Laskar S, Agarwal JP, Upreti RR, Budrukkar A, Murthy V, Deshpande DD, Shrivastava SK, Dinshaw KA, Cozzi L: Volumetric modulated arc radiotherapy for carcinomas of the oro-pharynx, hypo-pharynx and larynx: a treatment planning comparison with fixed field IMRT. Radiother Oncol 2009, 92: 111-117. 10.1016/j.radonc.2008.12.008CrossRefPubMed

17.

Duthoy W, De Gersem W, Vergote K, Boterberg T, Derie C, Smeets P, De Wagter C, De Neve W: Clinical implementation of intensity-modulated arc therapy (IMAT) for rectal cancer. Int J Radiat Oncol Biol Phys 2004, 60: 794-806. 10.1016/j.ijrobp.2004.04.016CrossRefPubMed

18.

Van Gestel D, van Vliet-Vroegindeweij C, Van den Heuvel F, Crijns W, Coelmont A, De Ost B, Holt A, Lamers E, Geussens Y, Nuyts S, Van den Weyngaert D, Van den Wyngaert T, Vermorken JB, Gregoire V: RapidArc, SmartArc and TomoHD compared with classical step and shoot and sliding window intensity modulated radiotherapy in an oropharyngeal cancer treatment plan comparison. Radiat Oncol 2013, 8: 37. 10.1186/1748-717X-8-37PubMedCentralCrossRefPubMed

19.

Wolff D, Stieler F, Welzel G, Lorenz F, Abo-Madyan Y, Mai S, Herskind C, Polednik M, Steil V, Wenz F, Lohr F: Volumetric modulated arc therapy (VMAT) vs. serial tomotherapy, step-and-shoot IMRT and 3D-conformal RT for treatment of prostate cancer. Radiother Oncol 2009, 93: 226-233. 10.1016/j.radonc.2009.08.011CrossRefPubMed

20.

Kan MW, Wong W, Leung LH, Yu PK, So RW, Cheng AC: A comprehensive dosimetric evaluation of using RapidArc volumetric-modulated arc therapy for the treatment of early-stage nasopharyngeal carcinoma. J Appl Clin Med Phys 2012, 13: 189-202.

21.

Thomas E, Popple R, Prendergast B, Clark G, Dobelbower M, Fiveasha J: Effects of flattening filter-free and volumetric-modulated arc therapy delivery on treatment efficiency. J Appl Clin Med Phys 2013, 14: 155-166.

22.

Palma D, Vollans E, James K: Volumetric modulated arc therapy for delivery of prostate radiotherapy: comparison with intensity-modulated radiotherapy and three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 2008, 72: 996-1001. 10.1016/j.ijrobp.2008.02.047CrossRefPubMed

23.

Vanetti E, Nicolini G, Nord J, Peltola J, Clivio A, Fogliata A, Cozzi L: On the role of the optimization algorithm of RapidArc® volumetric modulated arc therapy on plan quality and efficiency. Med Phys 2011, 38: 5844-5856. 10.1118/1.3641866CrossRefPubMed

24.

Eclipse Algorithms Reference Guide. 3100 Hansen Way, Palo Alto, CA 94304-1030, USA: Varian Medical systems, Inc. Varian; 2011. Varian medical systems, P/N B503486R01B

25.

Van Esch A, Tillikainen L, Pyykkonen J, Tenhunen M, Helminen H, Siljamäki S, Alakuijala J, Paiusco M, Lori M, Huyskens DP: Testing of the analytical anisotropic algorithm for photon dose calculation. Med Phys 2006, 33: 4130-4148. 10.1118/1.2358333CrossRefPubMed

26.

Orvati CJ: Vergleich zweier Planverifikationsmethoden bei Rotationsbestrahlungen. Kantonsschule am Burggraben St. Gallen: Maturaarbeit; 2012.

27.

Van’t Riet A, Mak AC, Moerland MA, Elders LH, van der Zee W: A conformation number to quantify the degree of conformality in brachytherapy and external beam irradiation: application to the prostate. Int J Radiat Oncol Biol Phys 1997, 37: 731-736. 10.1016/S0360-3016(96)00601-3CrossRefPubMed

28.

Lafond C, Chajon E, Devillers A, Louvel G, Toublanc S, Olivier M, Simon A, De Crevoisier R, Manens JP: Impact of MLC leaf width on volumetric-modulated arc therapy planning for head and neck cancers. J Appl Clin Med Phys 2013, 14: 40-52.

29.

Hong C-S, Ju S-G, Kim M, Kim J, Suh TS, Han Y, Chan Y, Choi DH, Nam H, Park HC: Dosimetric effects of multileaf collimator leaf width on intensity-modulated radiotherapy for head and neck cancer. Med Phys 2014, 41: 021712-1-021712-10.

30.

van Kesteren Z, Janssen T, Damen E, van Vliet-Vroegindeweij C: The dosimetric impact of leaf interdigitation and leaf width on VMAT treatment planning in Pinnacle: comparing Pareto fronts. Phys Med Biol 2012, 57: 2943-2952. 10.1088/0031-9155/57/10/2943CrossRefPubMed

31.

Wiezorek T, Brachwitz T, Georg D, Blank E, Fotina I, Habl G, Kretschmer M, Lutters G, Salz H, Schubert K, Wagner D, Wendt TG: Rotational IMRT techniques compared to fixed gantry IMRT and Tomotherapy: multi-institutional planning study for head-and-neck cases. Radiat Oncol 2011, 6: 20. 10.1186/1748-717X-6-20PubMedCentralCrossRefPubMed

32.

Hall EJ, Wuu CS: Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 2003, 56: 83-88. 10.1016/S0360-3016(03)00073-7CrossRefPubMed

33.

Galvin JM, Ezzell G, Eisbrauch A, Yu C, Butler B, Xiao Y, Rosen I, Rosenman J, Sharpe M, Xing L, Xia P, Lomax T, Low DA, Palta J: Implementing IMRT in clinical practice: a joint document of the American Society for Therapeutic Radiology and Oncology and the American Association of Physicists in Medicine. Int J Radiat Oncol Biol Phys 2004, 58: 1616-1634. 10.1016/j.ijrobp.2003.12.008CrossRefPubMed

34.

Clivio A, Fogliata A, Franzetti-Pellanda A, Nicolini G, Vanetti E, Wyttenbach R, Cozzi L: Volumetric-modulated arc radiotherapy for carcinomas of the anal canal: a treatment planning comparison with fixed field IMRT. Radiother Oncol 2009, 92: 118-124. 10.1016/j.radonc.2008.12.020CrossRefPubMed

35.

D’Souza WD, Rosen II: Nontumor integral dose variation in conventional radiotherapy treatment planning. Med Phys 2003, 30: 2065-2071. 10.1118/1.1591991CrossRefPubMed

Title: A treatment planning study comparing Elekta VMAT and fixed field IMRT using the varian treatment planning system eclipse
Authors: Samuel Peters
Hans Schiefer
Ludwig Plasswilm
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-9-153

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A treatment planning study comparing Elekta VMAT and fixed field IMRT using the varian treatment planning system eclipse

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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