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Multi‐isocentric 4π volumetric‐modulated arc therapy approach for head and neck cancer
OBJECTIVES: To explore the feasibility of multi‐isocentric 4π volumetric‐modulated arc therapy (MI4π‐VMAT) for the complex targets of head and neck cancers. METHODS: Twenty‐five previously treated patients of HNC underwent re‐planning to improve the dose distributions with either coplanar VMAT techn...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874945/ https://www.ncbi.nlm.nih.gov/pubmed/28834021 http://dx.doi.org/10.1002/acm2.12164 |
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author | Subramanian, Vallinayagam Shanmuga Subramani, Vellaiyan Chilukuri, Srinivas Kathirvel, Murugesan Arun, Gandhi Swamy, Shanmugam Thirumalai Subramanian, Kala Fogliata, Antonella Cozzi, Luca |
author_facet | Subramanian, Vallinayagam Shanmuga Subramani, Vellaiyan Chilukuri, Srinivas Kathirvel, Murugesan Arun, Gandhi Swamy, Shanmugam Thirumalai Subramanian, Kala Fogliata, Antonella Cozzi, Luca |
author_sort | Subramanian, Vallinayagam Shanmuga |
collection | PubMed |
description | OBJECTIVES: To explore the feasibility of multi‐isocentric 4π volumetric‐modulated arc therapy (MI4π‐VMAT) for the complex targets of head and neck cancers. METHODS: Twenty‐five previously treated patients of HNC underwent re‐planning to improve the dose distributions with either coplanar VMAT technique (CP‐VMAT) or noncoplanar MI4π‐VMAT plans. The latter, involving 3–6 noncoplanar arcs and 2–3 isocenters were re‐optimized using the same priorities and objectives. Dosimetric comparison on standard metrics from dose‐volume histograms was performed to appraise relative merits of the two techniques. Pretreatment quality assurance was performed with IMRT phantoms to assess deliverability and accuracy of the MI4π‐VMAT plans. The gamma agreement index (GAI) analysis with criteria of 3 mm distance to agreement (DTA) and 3% dose difference (DD) was applied. RESULTS: CP‐VMAT and MI4π‐VMAT plans achieved the same degree of coverage for all target volumes related to near‐to‐minimum and near‐to‐maximum doses. MI4π‐VΜΑΤ plans resulted in an improved sparing of organs at risk. The average mean dose reduction to the parotids, larynx, oral cavity, and pharyngeal muscles were 3 Gy, 4 Gy, 5 Gy, and 4.3 Gy, respectively. The average maximum dose reduction to the brain stem, spinal cord, and oral cavity was 6.0 Gy, 3.8 Gy, and 2.4 Gy. Pretreatment QA results showed that plans can be reliably delivered with mean gamma agreement index of 97.0 ± 1.1%. CONCLUSIONS: MI4π‐VMAT plans allowed to decrease the dose‐volume‐metrics for relevant OAR and results are reliable from a dosimetric standpoint. Early clinical experience has begun and future studies will report treatment outcome. |
format | Online Article Text |
id | pubmed-5874945 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-58749452018-04-02 Multi‐isocentric 4π volumetric‐modulated arc therapy approach for head and neck cancer Subramanian, Vallinayagam Shanmuga Subramani, Vellaiyan Chilukuri, Srinivas Kathirvel, Murugesan Arun, Gandhi Swamy, Shanmugam Thirumalai Subramanian, Kala Fogliata, Antonella Cozzi, Luca J Appl Clin Med Phys Radiation Oncology Physics OBJECTIVES: To explore the feasibility of multi‐isocentric 4π volumetric‐modulated arc therapy (MI4π‐VMAT) for the complex targets of head and neck cancers. METHODS: Twenty‐five previously treated patients of HNC underwent re‐planning to improve the dose distributions with either coplanar VMAT technique (CP‐VMAT) or noncoplanar MI4π‐VMAT plans. The latter, involving 3–6 noncoplanar arcs and 2–3 isocenters were re‐optimized using the same priorities and objectives. Dosimetric comparison on standard metrics from dose‐volume histograms was performed to appraise relative merits of the two techniques. Pretreatment quality assurance was performed with IMRT phantoms to assess deliverability and accuracy of the MI4π‐VMAT plans. The gamma agreement index (GAI) analysis with criteria of 3 mm distance to agreement (DTA) and 3% dose difference (DD) was applied. RESULTS: CP‐VMAT and MI4π‐VMAT plans achieved the same degree of coverage for all target volumes related to near‐to‐minimum and near‐to‐maximum doses. MI4π‐VΜΑΤ plans resulted in an improved sparing of organs at risk. The average mean dose reduction to the parotids, larynx, oral cavity, and pharyngeal muscles were 3 Gy, 4 Gy, 5 Gy, and 4.3 Gy, respectively. The average maximum dose reduction to the brain stem, spinal cord, and oral cavity was 6.0 Gy, 3.8 Gy, and 2.4 Gy. Pretreatment QA results showed that plans can be reliably delivered with mean gamma agreement index of 97.0 ± 1.1%. CONCLUSIONS: MI4π‐VMAT plans allowed to decrease the dose‐volume‐metrics for relevant OAR and results are reliable from a dosimetric standpoint. Early clinical experience has begun and future studies will report treatment outcome. John Wiley and Sons Inc. 2017-08-20 /pmc/articles/PMC5874945/ /pubmed/28834021 http://dx.doi.org/10.1002/acm2.12164 Text en © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Radiation Oncology Physics Subramanian, Vallinayagam Shanmuga Subramani, Vellaiyan Chilukuri, Srinivas Kathirvel, Murugesan Arun, Gandhi Swamy, Shanmugam Thirumalai Subramanian, Kala Fogliata, Antonella Cozzi, Luca Multi‐isocentric 4π volumetric‐modulated arc therapy approach for head and neck cancer |
title | Multi‐isocentric 4π volumetric‐modulated arc therapy approach for head and neck cancer |
title_full | Multi‐isocentric 4π volumetric‐modulated arc therapy approach for head and neck cancer |
title_fullStr | Multi‐isocentric 4π volumetric‐modulated arc therapy approach for head and neck cancer |
title_full_unstemmed | Multi‐isocentric 4π volumetric‐modulated arc therapy approach for head and neck cancer |
title_short | Multi‐isocentric 4π volumetric‐modulated arc therapy approach for head and neck cancer |
title_sort | multi‐isocentric 4π volumetric‐modulated arc therapy approach for head and neck cancer |
topic | Radiation Oncology Physics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874945/ https://www.ncbi.nlm.nih.gov/pubmed/28834021 http://dx.doi.org/10.1002/acm2.12164 |
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