Dosimetric comparison of three-dimensional conformal radiotherapy versus volumetric-arc radiotherapy in cervical cancer treatment: applying the central-shielding principle to modern technology

This study evaluated the feasibility of applying volumetric-arc radiotherapy (VMAT) in standard curative radiotherapy for non-bulky cervical cancer using the central-shielding principle. Whole-pelvis irradiation of 20 Gy and central-shielding pelvis irradiation of 30 Gy, both in 2 Gy fractions, were created using 3D conformal radiotherapy (3DCRT) with a standard midline block or VMAT. Composite dose distributions and DVH parameters were compared first in a simple phantom model and then in 10 clinical cases of Stage I–II cervical cancer. Whole-pelvis clinical target volumes (CTVs) were created from published guidelines for primary disease and lymph node regions, and CTVs for central-shielding irradiation were created by subtracting uterus corpus and 4 cm-wide regions centered at the cervical canal and vagina. In a phantom model, VMAT provided adequate dose coverage to the PTVs without excessive doses to the rectum or bladder compared with the 3DCRT plan. In the clinical cases, VMAT plans resulted in slightly but significantly better coverage of PTVs. The DVH parameters for the rectum and bladder were equivalent or lower for VMAT plans compared with the 3DCRT plans. In the bowel, V(30Gy), V(40Gy), and V(50Gy) were significantly lower in VMAT plans compared with in the 3DCRT plans (47.6% vs 61.0%, 29.8% vs 56.2% and 6.8% vs 21.1%, respectively). Based on these results, VMAT may be used in external-beam radiotherapy for early-stage cervical cancer by adopting the principle of central-shielding pelvis irradiation. Furthermore, VMAT is likely to reduce doses to the small bowel and may reduce gastrointestinal toxicities for these patients.