Dosimetric comparison of axilla and groin radiotherapy techniques for high-risk and locally advanced skin cancer

PURPOSE: Radiation therapy targeting axilla and groin lymph nodes improves regional disease control in locally advanced and high-risk skin cancers. However, trials generally used conventional two-dimensional radiotherapy (2D-RT), contributing towards relatively high rates of side effects from treatment. The goal of this study is to determine if three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), or volumetric-modulated arc therapy (VMAT) may improve radiation delivery to the target while avoiding organs at risk in the clinical context of skin cancer regional nodal irradiation. MATERIALS AND METHODS: Twenty patients with locally advanced/high-risk skin cancers underwent computed tomography simulation. The relevant axilla or groin planning target volumes and organs at risk were delineated using standard definitions. Paired t-tests were used to compare the mean values of several dose-volumetric parameters for each of the 4 techniques. RESULTS: In the axilla, the largest improvement for 3D-CRT compared to 2D-RT was for homogeneity index (13.9 vs. 54.3), at the expense of higher lung V(20) (28.0% vs. 12.6%). In the groin, the largest improvements for 3D-CRT compared to 2D-RT were for anorectum D(max) (13.6 vs. 38.9 Gy), bowel D(200cc) (7.3 vs. 23.1 Gy), femur D(50) (34.6 vs. 57.2 Gy), and genitalia D(max) (37.6 vs. 51.1 Gy). IMRT had further improvements compared to 3D-CRT for humerus D(mean) (16.9 vs. 22.4 Gy), brachial plexus D(5) (57.4 vs. 61.3 Gy), bladder D(5) (26.8 vs. 36.5 Gy), and femur D(50) (18.7 vs. 34.6 Gy). Fewer differences were observed between IMRT and VMAT. CONCLUSION: Compared to 2D-RT and 3D-CRT, IMRT and VMAT had dosimetric advantages in the treatment of nodal regions of skin cancer patients.