Dosimetric comparison between VMAT plans using the fast-rotating O-ring linac with dual-layer stacked MLC and helical tomotherapy for nasopharyngeal carcinoma

BACKGROUND: To compare the dosimetric profiles of volumetric modulated arc therapy (VMAT) plans using the fast-rotating O-ring linac (the Halcyon system) based on a dual-layer stacked multi-leaf collimator and helical tomotherapy (HT) for nasopharyngeal cancer (NPCa). METHODS: For 30 NPCa patients, three sets of RT plans were generated, under the same policy of contouring and dose constraints: HT plan; Halcyon VMAT plan with two arcs (HL(2arc)); and Halcyon VMAT plan with four arcs (HL(4arc)), respectively. The intended dose schedule was to deliver 67.2 Gy to the planning gross target volume (P-GTV) and 56.0 Gy to the planning clinical target volume (P-CTV) in 28 fractions using the simultaneously integrated boost concept. Target volumes and organ at risks dose metrics were evaluated for all plans. Normal tissue complication probabilities (NTCP) for esophagus, parotid glands, spinal cord, and brain stem were compared. RESULTS: The HT plan achieved the best dose homogeneity index for both P_GTV and P_CTV, followed by the HL(4arc) and L(2arc) plans. No significant difference in the dose conformity index (CI) for P_GTV was observed between the HT plan (0.80) and either the HL(2arc) plan (0.79) or the HL(4arc) plan (0.83). The HL(4arc) plan showed the best CI for P_CTV (0.88), followed by the HL(2arc) plan (0.83) and the HT plan (0.80). The HL(4arc) plan (median, interquartile rage (Q1, Q3): 25.36 (22.22, 26.89) Gy) showed the lowest D(mean) in the parotid glands, followed by the HT (25.88 (23.87, 27.87) Gy) and HL(2arc) plans (28.00 (23.24, 33.99) Gy). In the oral cavity (OC) dose comparison, the HT (22.03 (19.79, 24.85) Gy) plan showed the lowest D(mean) compared to the HL(2arc) (23.96 (20.84, 28.02) Gy) and HL(4arc) (24.14 (20.17, 27.53) Gy) plans. Intermediate and low dose regions (40–65% of the prescribed dose) were well fit to the target volume in HL(4arc), compared to the HT and HL(2arc) plans. All plans met the dose constraints for the other OARs with sufficient dose margins. The between-group differences in the median NTCP values for the parotid glands and OC were < 3.47% and < 1.7% points, respectively. CONCLUSIONS: The dosimetric profiles of Halcyon VMAT plans were comparable to that of HT, and HL(4arc) showed better dosimetric profiles than HL(2arc) for NPCa. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13014-022-02124-0.