Comparative Analysis of Halcyon IMRT and VMAT Plans with DMX IMRT Plans for Tongue Cancer

Document Type : Original Paper

Authors

Department of Radiation Oncology, Sri Aurobindo Institute of Medical Sciences, India

10.22038/ijmp.2025.85741.2506

Abstract

Introduction: To determine the most effective treatment plan for tongue cancers, a comparative analysis is being conducted between Intensity-Modulated Radiation Therapy (IMRT_D) plans on the Clinac DMX system and both Volumetric Modulated Arc Therapy (VMAT_H) and IMRT_H plans for Halcyon Elite machine.
Material and Methods: A retrospective study was conducted on 20 patients with tongue cancers. A total dose of 60 Gy was delivered in two phases (i.e., 50 Gy for Elective and 10 Gy for Boost). All patients were treated using VMAT plans with unflattened beams from Varian Halcyon Elite (VMAT_H). For comparison, 40 equivalent IMRT plans with unflattened and flattened beams were created for Varian Halcyon Elite and Varian Clinac DMX (IMRT_H and IMRT_D). Plan parameters such as Homogeneity, Conformity, and Gradient Indices, along with OAR doses, were compared across the three plans.
Results: This study reveals that the HI of IMRT_H plans is significantly lower (P<0.05) compared to IMRT_D and VMAT_H plans. The CI and GI of IMRT_H and VMAT_H plans are significantly lower (P<0.05) than those of IMRT_D plans. VMAT_H plans and IMRT_H treatment plans achieve lower doses of OARs, showing a significant difference in statistics compared to IMRT_D plans. The Monitor Units required by VMAT_H plans are significantly lower (P<0.05) than those of IMRT_D and IMRT_H plans.
Conclusion: Volumetric Modulated Arc Therapy planned with Halcyon Elite configuration is suggested for the treatment of patients with tongue cancers. VMAT_H and IMRT_H plans were similar in plan parameters and OAR sparing, but VMAT_H required fewer Monitor Units.

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References

  1. World Health Organization. Global oral health status report: towards universal health coverage for oral health by 2030. Geneva: World Health Organization; 2022.
  2. Ray CS. IARC handbooks on cancer prevention, volume 19: oral cancer prevention. Indian J Cancer. 2024;61(1):144–
  3. Zhu Y, Zhou C, He Q. Radiation therapy’s efficacy on tongue cancer: a population-based survival analysis. Onco Targets Ther. 2018;11:7271–
  4. Van Esch A, Tillikainen L, Pyykkonen J, Tenhunen M, Helminen H, Siljamäki S, et al. Testing of the analytical anisotropic algorithm for photon dose calculation. Med Phys. 2006;33(11):4130–
  5. Prescribing, Recording, and Reporting Photon-Beam Intensity-Modulated Radiation Therapy (IMRT). ICRU Report 83. Journal of ICRU. 2010; 10(1).
  6. Paddick I. A simple scoring ratio to index the conformity of radiosurgical treatment plans. J Neurosurg. 2000;93(Suppl 3):219–
  7. Paddick I, Lippitz B. A simple dose gradient measurement tool to complement the conformity index. J Neurosurg. 2006;105(Suppl):194–
  8. Kumar SAS, Vivekanandan N, Sriram P. A study on conventional IMRT and RapidArc treatment planning techniques for head and neck cancers. Rep Pract Oncol Radiother. 2012;17(3):168–
  9. Verbakel WFAR, Cuijpers JP, Hoffmans D, Bieker M, Slotman BJ, Senan S. Volumetric intensity-modulated arc therapy vs conventional IMRT in head and neck cancer: a comparative planning and dosimetric study. Int J Radiat Oncol Biol Phys. 2009;74(1):252–
  10. Arslan A, Sengul B. Comparison of radiotherapy techniques with flattening filter and flattening filter-free in lung radiotherapy according to the treatment volume size. Sci Rep. 2020;10(1):8983.
  11. Vassiliev ON, Kry SF, Kuban DA, Salehpour M, Mohan R, Titt U. Treatment planning study of prostate cancer intensity-modulated radiotherapy with a Varian Clinac operated without a flattening filter. Int J Radiat Oncol Biol Phys. 2007;68(5):1567–
  12. Treutwein M, Hipp M, Koelbl O, Dobler B. Volumetric-modulated arc therapy and intensity-modulated radiation therapy treatment planning for prostate cancer with flattened beam and flattening filter-free linear accelerators. J Appl Clin Med Phys. 2017;18(5):307–
  13. Nithya L, Raj NA, Kumar A, Rathinamuthu S, Pandey MB. Comparative analysis of volumetric-modulated arc therapy and intensity-modulated radiotherapy for base of tongue cancer. J Med Phys. 2014;39(2):121–
  14. Michiels S, Poels K, Crijns W, Delombaerde L, De Roover R, Vanstraelen B, et al. Volumetric modulated arc therapy of head and neck cancer on a fast-rotating O-ring linac: plan quality and delivery time comparison with a C-arm linac. Radiother Oncol. 2018;128(3):479–
  15. Sarkar B, Biswal SS, Shahid T, Ghosh T, Bhattacharya J, De A, et al. Comparative dosimetric analysis of volumetric modulated arc therapy-based craniospinal irradiation plans between Halcyon ring gantry and TrueBeam C-arm linear accelerator. Sci Rep. 2023;13(1):30429.
  16. Pokhrel D, Visak J, Critchfield LC, Stephen J, Bernard ME, Randall M, et al. Clinical validation of ring-mounted Halcyon linac for lung SBRT: comparison to SBRT-dedicated C-arm linac treatments. J Appl Clin Med Phys. 2020;22(1):261–
  17. Hall EJ. Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys. 2006;65(1):1–
  18. Palanivelu D, Khanna D, Mohandass P, Panda D, Bhalla NK, Abraham SK, et al. Quantitative analysis of parotid sparing and reducing xerostomia using volumetric modulated arc therapy in oral cancer patients. Iran J Med Phys. 2023;20:100–

 

 

 

 

 

Iranian Journal of Medical Physics
Volume 22, Issue 4 - Serial Number 4
July and August 2025
Pages 261-269

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History

  • Receive Date: 30 January 2025
  • Revise Date: 04 October 2025
  • Accept Date: 07 October 2025

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