Dosimetric Comparison between Dynamic Wave Arc and Co-Planar Volumetric Modulated Radiotherapy for Locally Advanced Pancreatic Cancer

Document Type : Original Paper

Authors

1 Department of Clinical Oncology, Sohag University Hospital, Sohag University, Sohag, Egypt; and Guest Research Associate, Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

2 Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

3 Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan.

4 Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University; and Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

5 Department of Clinical Oncology, Sohag University Hospital, Sohag University, Sohag, Egypt.

6 Department of Radiation Oncology and Image-Applied Therapy Kyoto University Graduate School of Medicine、Kyoto, Japan.

Abstract

Introduction: Dose reduction to the duodenum is important to decrease gastrointestinal toxicities in patients with locally advanced pancreatic cancer (LAPC) treated with definitive chemoradiotherapy. We aimed to compare dynamic wave arc (DWA), a volumetric-modulated beam delivery technique with simultaneous gantry/ring rotations passing the waved trajectories, with coplanar VMAT (co-VMAT) with respect to dose distributions in LAPC cases.
Material and Methods: DWA and co-VMAT plans were created for 13 patients with LAPC. The prescribed dose was 45.6 or 48 Gy in 15 fractions. The dose volume indices (DVIs) for target volumes and organs at risk were compared between the corresponding plans. Gamma passing rate, monitor unit (MU), and beam-on time were also compared. 
Results: DWA significantly reduced the duodenal V39Gy, V42Gy, and V45Gy by 1.1, 0.8, and 0.2 cm3, and increased the liver mean dose and D2cm3 of the spinal cord planning volume by 1.0 and 1.5 Gy, respectively. Meanwhile, there was no significant difference in the target volumes except for D2% of PTV (111.5% in DWA vs. 110.5% in co-VMAT). Further, the gamma passing rate was similar in both plans. MU and beam-on time increased in DWA by 31 MUs and 15 seconds, respectively. 
Conclusion: DWA generated significantly lower duodenal doses in LAPC cases, albeit with slight increasing liver and spinal cord doses and increasing MU and the beam delivery time. Further evaluation is needed to know how the dose differences would affect the clinical outcomes in chemoradiotherapy for LAPC.

Keywords

Main Subjects

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–
  2. Stathis A, Moore MJ. Advanced pancreatic carcinoma: current treatment and future challenges. Nat Rev Clin Oncol. 2010;7(3):163–
  3. Hammel P, Huguet F, van Laethem J-L, Goldstein D, Glimelius B, Artru P, et al. Effect of Chemoradiotherapy vs Chemotherapy on Survival in Patients With Locally Advanced Pancreatic Cancer Controlled After 4 Months of Gemcitabine With or Without Erlotinib: The LAP07 Randomized Clinical Trial. JAMA. 2016;315(17):1844–
  4. Peixoto RD, Speers C, McGahan CE, Renouf DJ, Schaeffer DF, Kennecke HF. Prognostic factors and sites of metastasis in unresectable locally advanced pancreatic cancer. Cancer Med. 2015;4(8):1171–
  5. Robin TP, Goodman KA. Radiation therapy in the management of pancreatic adenocarcinoma: review of current evidence and future opportunities. Chinese Clin Oncol. 2017;6(3):28.
  6. Lee KJ, Yoon HI, Chung MJ, Park JY, Bang S, Park S, et al. A Comparison of Gastrointestinal Toxicities between Intensity-Modulated Radiotherapy and Three-Dimensional Conformal Radiotherapy for Pancreatic Cancer. Gut Liver. 2016;10(2):303–
  7. Goto Y, Nakamura A, Ashida R, Sakanaka K, Itasaka S, Shibuya K, et al. Clinical evaluation of intensity-modulated radiotherapy for locally advanced pancreatic cancer. Radiat Oncol. 2018;13(1):118.
  8. Prasad S, Cambridge L, Huguet F, Chou JF, Zhang Z, Wu AJ, et al. Intensity modulated radiation therapy reduces gastrointestinal toxicity in locally advanced pancreas cancer. Pract Radiat Oncol. 2016;6(2):78–
  9. Jin L, Wang R, Jiang S, Yue J, Liu T, Dou X, et al. Dosimetric and clinical toxicity comparison of critical organ preservation with three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and RapidArc for the treatment of locally advanced cancer of the pancreatic head. Curr Oncol. 2016;23(1): e41-8.
  10. Yovino S, Poppe M, Jabbour S, David V, Garofalo M, Pandya N, et al. Intensity-modulated radiation therapy significantly improves acute gastrointestinal toxicity in pancreatic and ampullary cancers. Int J Radiat Oncol Biol Phys. 2011;79(1):158–
  11. Audet C, Poffenbarger BA, Chang P, Jackson PS, Lundahl RE, Ryu SI, et al. Evaluation of volumetric modulated arc therapy for cranial radiosurgery using multiple noncoplanar arcs. Med Phys. 2011;38(11):5863–
  12. Uto M, Mizowaki T, Ogura K, Hiraoka M. Non-coplanar volumetric-modulated arc therapy (VMAT) for craniopharyngiomas reduces radiation doses to the bilateral hippocampus: a planning study comparing dynamic conformal arc therapy, coplanar VMAT, and non-coplanar VMAT. Radiat Oncol. 2016;11(1):86.
  13. Wilson B, Otto K, Gete E. A simple and robust trajectory-based stereotactic radiosurgery treatment. Med Phys. 2017;44(1):240–
  14. Fix MK, Frei D, Volken W, Terribilini D, Mueller S, Elicin O, et al. Part 1: Optimization and evaluation of dynamic trajectory radiotherapy. Med Phys. 2018;45(9):4201–
  15. Mizowaki T, Takayama K, Nagano K, Miyabe Y, Matsuo Y, Kaneko S, et al. Feasibility evaluation of a new irradiation technique: three-dimensional unicursal irradiation with the Vero4DRT (MHI-TM2000). J Radiat Res. 2013;54(2):330–
  16. Burghelea M, Verellen D, Dhont J, Hung C, Gevaert T, Van den Begin R, et al. Treating patients with Dynamic Wave Arc: First clinical experience. Radiother Oncol. 2017;122(3):347–
  17. Uto M, Mizowaki T, Ogura K, Miyabe Y, Nakamura M, Mukumoto N, et al. Volumetric modulated Dynamic WaveArc therapy reduces the dose to the hippocampus in patients with pituitary adenomas and craniopharyngiomas. Pract Radiat Oncol. 2017;7(6):382–
  18. Nakamura K, Mizowaki T, Uto M, Mukumoto N, Miyabe Y, Ono T, et al. EP-1553: Dose reduction of femoral heads using volumetric-modulated Dynamic WaveArc for prostate cancer. Radiother Oncol. 2017;123:S836–
  19. Burghelea M, Verellen D, Poels K, Hung C, Nakamura M, Dhont J, et al. Initial characterization, dosimetric benchmark and performance validation of Dynamic Wave Arc. Radiat Oncol. 2016;11(1):63.
  20. Nakamura A, Shibuya K, Nakamura M, Matsuo Y, Shiinoki T, Nakata M, et al. Interfractional dose variations in the stomach and the bowels during breathhold intensity-modulated radiotherapy for pancreatic cancer: Implications for a dose-escalation strategy. Med Phys. 2013;40(2):021701.
  21. Goto Y, Ashida R, Nakamura A, Itasaka S, Shibuya K, Akimoto M, et al. Clinical results of dynamic tumor tracking intensity-modulated radiotherapy with real-time monitoring for pancreatic cancers using a gimbal mounted linac. Oncotarget. 2018;9(34):23628–
  22. Nakamura A, Hiraoka M, Itasaka S, Nakamura M, Akimoto M, Ishihara Y, et al. Evaluation of Dynamic Tumor-tracking Intensity-modulated Radiotherapy for Locally Advanced Pancreatic Cancer. Sci Rep. 2018;8(1):17096.
  23. Miften M, Olch A, Mihailidis D, Moran J, Pawlicki T, Molineu A, et al. Tolerance limits and methodologies for IMRT measurement-based verification QA: Recommendations of AAPM Task Group No. 218. Med Phys. 2018;45(4):e53–
  24. Rubin P, Casarett GW. Clinical radiation pathology as applied to curative radiotherapy. Cancer. 1968;22(4):767–
  25. Krishnan S, Chadha AS, Suh Y, Chen H-C, Rao A, Das P, et al. Focal Radiation Therapy Dose Escalation Improves Overall Survival in Locally Advanced Pancreatic Cancer Patients Receiving Induction Chemotherapy and Consolidative Chemoradiation. Int J Radiat Oncol Biol Phys. 2016;94(4):755–
  26. Nakamura A, Shibuya K, Matsuo Y, Nakamura M, Shiinoki T, Mizowaki T, et al. Analysis of dosimetric parameters associated with acute gastrointestinal toxicity and upper gastrointestinal bleeding in locally advanced pancreatic cancer patients treated with gemcitabine-based concurrent chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2012;84(2):369–
  27. Huang J, Robertson JM, Ye H, Margolis J, Nadeau L, Yan D. Dose-volume analysis of predictors for gastrointestinal toxicity after concurrent full-dose gemcitabine and radiotherapy for locally advanced pancreatic adenocarcinoma. Int J Radiat Oncol Biol Phys. 2012;83(4):1120–
  28. Kelly P, Das P, Pinnix CC, Beddar S, Briere T, Pham M, et al. Duodenal toxicity after fractionated chemoradiation for unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys. 2013;85(3):e143-9.
  29. Liu X, Ren G, Li L, Xia T. Predictive dosimetric parameters for gastrointestinal toxicity with hypofractioned radiotherapy in pancreatic adenocarcinoma. Onco Targets Ther. 2016;9:2489–
  30. Badiyan SN, Olsen JR, Lee AY, Yano M, Menias CO, Khwaja S, et al. Induction Chemotherapy Followed by Concurrent Full-dose Gemcitabine and Intensity-modulated Radiation Therapy for Borderline Resectable and Locally Advanced Pancreatic Adenocarcinoma. Am J Clin Oncol. 2016;39(1):1–
  31. Krishnan S, Rana V, Janjan NA, Varadhachary GR, Abbruzzese JL, Das P, et al. Induction chemotherapy selects patients with locally advanced, unresectable pancreatic cancer for optimal benefit from consolidative chemoradiation therapy. Cancer. 2007;110(1):47–
  32. Campbell WG, Jones BL, Schefter T, Goodman KA, Miften M. An evaluation of motion mitigation techniques for pancreatic SBRT. Radiother Oncol. 2017;124(1):168–
  33. Lens E, Gurney-Champion OJ, Tekelenburg DR, van Kesteren Z, Parkes MJ, van Tienhoven G, et al. Abdominal organ motion during inhalation and exhalation breath-holds: pancreatic motion at different lung volumes compared. Radiother Oncol. 2016;121(2):268–
  34. Nakamura M, Shibuya K, Shiinoki T, Matsuo Y, Nakamura A, Nakata M, et al. Positional reproducibility of pancreatic tumors under end-exhalation breath-hold conditions using a visual feedback technique. Int J Radiat Oncol Biol Phys. 2011;79(5):1565–

 

Iranian Journal of Medical Physics
Volume 19, Issue 1
January and February 2022
Pages 1-8

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History

  • Receive Date: 16 February 2021
  • Revise Date: 19 April 2021
  • Accept Date: 27 April 2021

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