Influence of increment of gantry angle and number of arcs on esophageal volumetric modulated arc therapy planning in Monaco planning system: A planning study

The objective of this study was to analyze the influence of the increment of gantry angle and the number of arcs on esophageal volumetric modulated arc therapy plan. All plans were done in Monaco planning system for Elekta Synergy linear accelerator with 80 multileaf collimator (MLC). Volumetric modulated arc therapy (VMAT) plans were done with different increment of gantry angle like 15°, 20°, 30° and 40°. The remaining parameters were similar for all the plans. The results were compared. To compare the plan quality with number of arcs, VMAT plans were done with single and dual arc with increment of gantry angle of 20°. The dose to gross tumor volume (GTV) for 60 Gy and planning target volume (PTV) for 48 Gy was compared. The dosimetric parameters D(98%), D(95%), D(50%) and D(max) of GTV were analyzed. The homogeneity index (HI) and conformity index (CI) of GTV were studied and the dose to 98% and 95% of PTV was analyzed. Maximum dose to spinal cord and planning risk volume of cord (PRV cord) was compared. The Volume of lung receiving 10 Gy, 20 Gy and mean dose was analyzed. The volume of heart receiving 30 Gy and 45 Gy was compared. The volume of normal tissue receiving greater than 2 Gy and 5 Gy was compared. The number of monitor units (MU) required to deliver the plans were compared. The plan with larger increment of gantry angle proved to be superior to smaller increment of gantry angle plans in terms of dose coverage, HI, CI and normal tissue sparing. The number of arcs did not make any difference in the quality of the plan.