Comparison of Volumetric Modulated Arc Therapy and Three-Dimensional Conformal Radiotherapy in Postoperative High-Grade Glioma: A Dosimetric Comparison

Document Type : Original Paper

Authors

1 Department of Radiation Oncology, Dr. Ram Manohar Lohia, Institute of Medical Sciences, Vibhuti khand, Gomti Nagar, Lucknow, India

2 Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand Gomti Nagar, Lucknow -226010 India

3 Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand Gomti Nagar, Lucknow -226010

Abstract

Introduction: We aimed to dosimetrically compare three-dimensional conformal radiotherapy (3D-CRT) and volumetric modulated arc therapy (VMAT) in terms of planning target volume (PTV) coverage, organ at risk (OAR) sparing, and conformity index (CI).
Material and Methods: Planning data of 26 high grade glioma (HGG) patients were used. Prescribed dose for 3D-CRT was 46Gy in 23 fractions to low-risk PTV (LR-PTV) and 14 Gy in 7 fractions to high-risk PTV (HR-PTV). VMAT plans were conducted using 46 Gy in 30 fractions to LR-PTV and 60 Gy in 30 fractions to HR-PTV.
Results: Tumor locations were frontal, parietal, temporal, and multi-lobed in 27%, 15%, 23%, and 35% of cases, respectively. Histology was glioblastoma multiform in 89% of patients. Mean values of PTV D95 (dose received by 95% volume) in 3D-CRT and VMAT were 96.6% and 98.8% for the LR-PTV and 97.3% and 99% for HR-PTV (p <0.001), respectively. Mean values of CI in 3D-CRT were 0.96 and 0.97 for LR-PTV and HR-PTV and 0.98 and 0.99 for LR-PTV and HR-PTV of VMAT (both p <0.001), respectively. Mean Dmax of right optic nerve (maximum point dose received by the organ) for 3D-CRT and VMAT were 31.59 and 25.57Gy (P=0.02). Mean Dmax for left optic nerve and optic chiasm were 28.81 and 22.14 Gy (P=0.019) and 42.24 and 37.12 Gy (P=0.055) respectively for 3D-CRT versus VMAT. Doses to other OARs were not statistically different between 3D-CRT and VMAT.
Conclusion: VMAT achieved better coverage of the PTV and delivered fewer doses to bilateral optic nerve and chiasm.

Keywords

Main Subjects

References

  1.  

    1. Ostrom QT, Gittleman H, Fulop J, Liu M, Blanda R, Kromer C, et al. CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2008-2012. Neuro Oncol. 2015;17:1-62.
    2. Siker ML, Donahue BR, Vogelbaum MA. Primary Intracranial Neoplasms. In: Halperin EC, Parez CA, Brady LW, editors. Perez and Brady’s Principles and Practice of Radiation Oncology. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2008;718-50
    3. Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol. 2009;10(5):459–66.
    4. Stupp R, Mason W, van den Bent MJ, Weller M, Fisher BM, Taphoorn MJB, et al. Radiotherapy plus Concomitantnand Adjuvant Temozolomide for Glioblastoma. N Engl J Med. 2005; 352(10):987-96.
    5. Tran B, Rosenthal MA. Survival comparison between glioblastoma multiforme and other incurable cancers. J Clin Neurosci. 2010 ;17(4):417-21.
    6. Nuño M, Birch K, Mukherjee D, Sarmiento JM, Black KL, Patil CG. Survival and prognostic factors of anaplastic gliomas. Neurosurgery. 2013;73(3):458–65.
    7. Cairncross G, Wang M, Shaw E, Jenkins R, Brachman D, Buckner J, et al. Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: Long-term results of RTOG 9402. J Clin Oncol. 2013;31(3):337–43.
    8. Hermanto U, Frija EK, Lii MJ, Chang EL, Mahajan A, Woo SY. Intensity-modulated radiotherapy (IMRT) and conventional three-dimensional conformal radiotherapy for high-grade gliomas: Does IMRT increase the integral dose to normal brain?. Int J Radiat Oncol Biol Phys. 2007;67(4):1135–44.
    9. Chan MF, Schupak K, Burman C, Chui C-S, Ling CC. Comparison of intensity-modulated radiotherapy with three-dimensional conformal radiation therapy planning for glioblastoma multiforme. Med Dosim. 2003;28(4):261–5.
    10. Narayana A, Yamada J, Berry S, Shah P, Hunt M, Gutin PH, et al. Intensity-modulated radiotherapy in high-grade gliomas: Clinical and dosimetric results. Int J Radiat Oncol Biol Phys. 2006;64(3):892–7.
    11. Vanetti E, Clivio A, Nicolini G, Fogliata A, Ghosh-Laskar S, Agarwal JP, et al. Volumetric modulated arc radiotherapy for carcinomas of the oro-pharynx, hypo-pharynx and larynx: A treatment planning comparison with fixed field IMRT. Radiother Oncol. 2009;92(1):111–7.
    12. Zheng BM, Dong XX, Wu H, Duan YJ, Han SK, Sun Y. Dosimetry comparison between volumetric modulated arc therapy with rapidarc and fixed field dynamic IMRT for local-regionally advanced Nasopharyngeal Carcinoma. Chinese J Cancer Res. 2011;23(4):259–64.
    13. Doornaert P, Verbakel WF a R, Bieker M, Slotman BJ, Senan S. RapidArc planning and delivery in patients with locally advanced head-and-neck cancer undergoing chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2011;79(2):429–35.
    14. Stroom JC, Heijmen BJM. Geometrical uncertainties, radiotherapy planning margins, and the ICRU-62 report. Radiother Oncol. 2002;64(1):75–83.
    15. International Commission on Radiation Units and Measurements. ICRU Report 62. Prescribing, Recording, and Reporting Photon Beam Therapy (Supplement to ICRU Report 50). J ICRU. 1999.
    16. Stupp R, Hegi ME, Gorlia T, Erridge SC, Perry J, Hong YK, et al. Cilengitide combined with standard treatment for patients with newly diagnosed glioblastoma with methylated MGMT promoter (CENTRIC EORTC 26071-22072 study): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2014;15(10):1100–8.
    17. Paravati AJ, Heron DE, Landsittel D, Flickinger JC, Mintz A, Chen YF, et al. Radiotherapy and temozolomide for newly diagnosed glioblastoma and anaplastic astrocytoma: Validation of Radiation Therapy Oncology Group-Recursive Partitioning Analysis in the IMRT and temozolomide era. J Neurooncol. 2011;104(1):339–49.
    18. Shepard DM, Earl MA, Li XA, Naqvi S, Yu C. Direct aperture optimization: A turnkey solution for step-and-shoot IMRT. Med Phys. 2002;29(6):1007–18.
    19. Mayo C, Yorke E, Merchant TE. Radiation Associated Brainstem Injury. Int J Radiat Oncol Biol Phys. 2010; 76(3): 36–41.
    20. Emami B, Lyman J, Brown A, Cola L, Goitein M, Munzenrider JE, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991;21(1):109–22.
    21. Scoccianti S, Detti B, Gadda D, Greto D, Furfaro I, Meacci F, et al. Organs at risk in the brain and their dose-constraints in adults and in children: a radiation oncologist's guide for delineation in everyday practice. Radiother Oncol. 2015 Feb;114(2):230-8.
    22. MacDonald SM, Ahmad S, Kachris S, Vogds BJ, DeRouen M, Gittleman AE, et al. Intensity modulated radiation therapy versus three-dimensional conformal radiation therapy for the treatment of high grade glioma: a dosimetric comparison. J Appl Clin Med Phys. 2007;8(2):47–60.
    23. Feuvret L, Noël G, Mazeron JJ, Bey P. Conformity index: A review. International Journal of Radiation Oncology Biology Physics. 2006 ;64(2):333-42.
    24. Vieillot S, Azria D, Lemanski C, Moscardo CL, Gourgou S, Dubois JB, et al. Plan comparison of volumetric-modulated arc therapy (RapidArc) and conventional intensity-modulated radiation therapy (IMRT) in anal canal cancer. Radiat Oncol. 2010;5:92.
    25. Clivio A, Fogliata A, Franzetti-Pellanda A, Nicolini G, Vanetti E, Wyttenbach R, et al. Volumetric-modulated arc radiotherapy for carcinomas of the anal canal: A treatment planning comparison with fixed field IMRT. Radiother Oncol. 2009;92(1):118–24.
    26. Ansari S, Satpathy S, Paul S. Dose Distribution Analysis in Rapid Arc and IMRT Radiotherapy Plan in Head and Neck Cancer Using Multiple Parameters. Iranian Journal of Medical Physics. 2018. Doi: 10.22038/ijmp.2018.31896.1378.
    27. Bahreyni Toossi MT, Zare H, Eslami Z, Bayani Roodi S, Daneshdoust M, Saeed Z, et al. Assessment of Radiation Dose to the Lens of the Eye and Thyroid of Patients Undergoing Head and Neck Computed Tomography at Five Hospitals in Mashhad, Iran. Iranian Journal of Medical Physics. 2018; 15(4): 226-30.
    28. Bush K, Townson R, Zavgorodni S. Monte Carlo simulation of RapidArc radiotherapy delivery. Phys Med Biol. 2008;53(19): 359-70.
    29. Wagner D, Christiansen H, Wolff H, Vorwerk H. Radiotherapy of malignant gliomas: Comparison of volumetric single arc technique (RapidArc), dynamic intensity-modulated technique and 3D conformal technique. Radiother Oncol. 2009;93(3):593–6.
    30. Shaffer R, Nichol AM, Vollans E, Fong M, Nakano S, Moiseenko V, et al. A Comparison of Volumetric Modulated Arc Therapy and Conventional Intensity-Modulated Radiotherapy for Frontal and Temporal High-Grade Gliomas. Int J Radiat Oncol Biol Phys. 2010;76(4):1177–84.
    31. Zach L, Stall B, Ning H, Ondos J, Arora B, Uma S, et al. A dosimetric comparison of four treatment planning methods for high grade glioma. Radiat Oncol. 2009;4(1):45.
Iranian Journal of Medical Physics
Volume 16, Issue 5 - Serial Number 5
September and October 2019
Pages 385-391

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History

  • Receive Date: 14 November 2018
  • Revise Date: 19 February 2019
  • Accept Date: 03 March 2019

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