Dosimetric comparison of intensity-modulated radiation therapy and volumetric-modulated arc therapy plans for the treatment of glioma using flattening filter-free and flattening filter modes

Xu,Dandan; Jia,Fei; Li,Guowen; Li,Hongfei

doi:10.3892/ol.2017.5883

Dosimetric comparison of intensity-modulated radiation therapy and volumetric-modulated arc therapy plans for the treatment of glioma using flattening filter-free and flattening filter modes

Authors:
- Dandan Xu
- Fei Jia
- Guowen Li
- Hongfei Li
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Affiliations: Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
Published online on: March 21, 2017 https://doi.org/10.3892/ol.2017.5883
Pages: 3451-3456
Copyright: © Xu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

In the present study, the dose verification between 6X and 6X flattening filter-free (FFF) in intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) was compared, and the advantages and disadvantages of different radiotherapy plans were evaluated. All four plans achieved comparable heterogeneity and conformity indices. For frontal tumor, VMAT demonstrated more improved sparing of the brainstem compared with the IMRT (P=0.045); while in the model of FFF, the Dmax of eye lens was significantly reduced by 16‑21% (P<0.001). The organs at risk (OARs) in the temporal lobe tumor were spared well in the IMRT plan. With the removal of FF, the low‑dose volume for both tumor locations was significantly reduced (P<0.05). By contrast, there was no significant difference in monitor units (MUs) with FFF, but the MUs were significantly reduced in the VMAT plan (P<0.001). Regarding the protection of OARs, FFF appeared to be superior compared with FF. For the frontal glioma, the VMAT plan had more advantages, and for temporal lobe tumor, dynamic IMRT was more appropriate. The VMAT plan reduces the low‑dose volume of normal brain tissues and the MUs. While the removal of FF may increase the dose rate, the shortened treatment delivery time may improve the accuracy of treatment due to intra-fractional patient motion.

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1	Walker MD, Green SB, Byar DP, Alexander E Jr, Batzdorf U, Brooks WH, Hunt WE, MacCarty CS, Mahaley MS Jr, Mealey J Jr, et al: Randomized comparison of radiotherapy and nitrosoureas for the malignant glioma after surgery. N Eng J Med. 303:1323–1329. 1980. View Article : Google Scholar
2	Chan MF, Schupak K, Barman C, Chui CS and Ling CC: Comparison of intensity-modulated radiotherapy with three-dimensional conformal therapy planning for glioblastoma muhiforme. Med Dosim. 28:261–265. 2003. View Article : Google Scholar : PubMed/NCBI
3	Narayana A, Yamade J, Berry S, Shah P, Hunt M, Gutin PH and Leibel SA: Intensity modulated radiotherapy in high grade glimas: Clinical and dosimetric result. Int J Radiat Oncol Biol Phys. 64:892–907. 2006. View Article : Google Scholar : PubMed/NCBI
4	Bragg CM, Conw J and Robinson MH: The role of intensity-modualated radiotherapy in treatment of parotid tumors. Int J Radiat Oncol Biol Phys. 52:729–738. 2002. View Article : Google Scholar : PubMed/NCBI
5	Vanetti E, Clivio A, Nicolini G, Fogliata A, Ghosh-Laskar S, Agarwal JP, Upreti RR, Budrukkar A, Murthy V, Deshpande DD, 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. 92:111–117. 2009. View Article : Google Scholar : PubMed/NCBI
6	Verbakel WF, Cuijpers JP, Hoffmans D, Bieker M, Slotman BJ and 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. 74:252–259. 2009. View Article : Google Scholar : PubMed/NCBI
7	Wu Hao, Han Shukui, Sun Yan and Jiang Fan: Dosimetric comparison of RapidArc with fixed gantry dynamic IMRT for loco-regionally advanced nasopharyngeal carcinoma. Chinese Journal of Radiation Oncology. 19:410–413. 2010.
8	Clemente S, Wu B, Sanguineti G, Fusco V, Ricchetti F, Wong J and McNutt T: SmartArc-based Volumetric modulated arc therapy for oropharyngeal cancer: A dosimetric comparison with both intensity-modulated radiation therapy and helical tomotherapy. Int J Radiat Oncol Biol Phys. 80:1248–1255. 2011. View Article : Google Scholar : PubMed/NCBI
9	Doornaert P, Verbakel WF, Bieker M, Slotman BJ and Senan S: Rapid Arc planning and delivery in patients with locally advanced head-and-neck cancer undergoing chemoradiotherapy. Int J Radiat Oncol Biol Phys. 79:429–435. 2011. View Article : Google Scholar : PubMed/NCBI
10	Sixel KE and Faddegon BA: Calculation of x-ray spectra for radiosurgical beams. Med Phys. 22:1657–1661. 1995. View Article : Google Scholar : PubMed/NCBI
11	Vassiliev ON, Titt U, Pönisch F, Kry SF, Mohan R and Gillin MT: Dosimetric properties of photon beams from a flattening filter free clinical accelerator. Phys Med Biol. 51:1907–1917. 2006. View Article : Google Scholar : PubMed/NCBI
12	Cashmore J: The characterization of unflattened photon beams from a 6 MV linear accelerator. Phys Med Biol. 53:1933–1946. 2008. View Article : Google Scholar : PubMed/NCBI
13	Kragl G, Wetterstedt Af S, Knäusl B, Lind M, McCavana P, Knöös T, McClean B and Georg D: Dosimetric characteristics of 6 and 10MV unflattened photon beams. Radiother Oncol. 93:141–146. 2009. View Article : Google Scholar : PubMed/NCBI
14	Baltas D, Kolotas C, Geramani K, Mould RF, Ioannidis G, Kekchidi M and Zamboglou N: A conformal index (COIN) to evaluate implant quality and dose specification in brachytherapy. Int J Radiat Oncol Biol Phys. 40:515–524. 1998. View Article : Google Scholar : PubMed/NCBI
15	Zwahlen DR, Lang S, Hrbacek J, Glanzmann C, Kloeck S, Najafi Y, Streller T, Studer G, Zaugg K and Luetolf UM: The use of photon beams of a flattening filter-free linear accelerator for hypofractionated volumetric modulated arc therapy in localized prostate cancer. Int J Radiat Oncol Biol Phys. 83:1655–1660. 2012. View Article : Google Scholar : PubMed/NCBI
16	Alongi F, Fogliata A, Clerici E, Navarria P, Tozzi A, Comito T, Ascolese AM, Clivio A, Lobefalo F, Reggiori G, et al: Volumetric modulated arc therapy with flattening filter free beams for isolated abdominal/pelvic lymph nodes: Report of dosimetric and early clinical results in oligometastatic patients. Radiat Oncol. 7:2042012. View Article : Google Scholar : PubMed/NCBI
17	Cao D, Holmes TW, Afghan MK and Shepard DM: Comparison of plan quality provided by intensity-modulated arc therapy and helical tomotherapy. Int J Radial Oncol Biol Phys. 69:240–250. 2007. View Article : Google Scholar
18	Palms D, Vollans E, James K, Nakano S, Moiseenko V, Shaffer R, McKenzie M, Morris J and Otto K: Volumetrie modulated arc therapy for delivery of prostate radiotherapy. Comparison with intensity-modulated radiotherapy and three-dimensional conformal radiotherapy. Int J Radial Oncol Biol Phys. 72:996–1001. 2008. View Article : Google Scholar