Cervix cancer radiotherapyA treatment planning study comparing volumetric arc modulation with RapidArc and fixed field IMRT for cervix uteri radiotherapy
Section snippets
Patient selection and planning objectives
CT data for a cohort of eight patients from the TMH centre were selected for this comparative analysis. All patients were affected by carcinoma of the cervix uteri to be treated with curative intent. For all patients, plans were designed on CT scans acquired with 5 mm slice thickness extending the scan from T11 to include the proximal third of the femur’s diaphysis. The OAR considered were: rectum, bladder, femoral heads and the small bowel. For rectum and bladder, two sets of OARs were defined
Results
Dose distributions are shown for one example in Fig. 1 for axial and coronal views. This figure allows visualisation of the main characteristics of RapidArc compared to IMRT, with a systematic reduction of bladder and rectum involvement and a reduced dose bath. Similar results were obtained for the other patients and through the entire extension of the target volume.
Fig. 2 shows the average DVH for the PTV comparing in 2a RapidArc (solid lines) to IMRT (dashed lines) while Fig. 2b (RapidArc)
Discussion
This study reports a comparison of the RapidArc technique compared to fixed beam IMRT. Similar investigations on different indications are appearing. Palma et al. investigated RapidArc progenitor on prostate showing that variable dose rate volumetric arc modulation is beneficial compared to IMRT or constant dose rate [29]. Fogliata et al. investigated RapidArc on small benign brain tumors compared to IMRT and helical tomotherapy [16]. It is expected that in a relatively short time-frame a
Conclusions
RapidArc was investigated for cervix uteri cancer and led to highly significant improvements in OAR and healthy tissue sparing with uncompromised target coverage compared to conventional IMRT. This is equivalent to a highly improved degree of conformal avoidance treatment. In addition, healthy tissue involvement, at short and long distancenear and far from the target and at both high and very low dose levels was improved with RapidArc compared to IMRT. The potential benefit of the better
Acknowledgements
The study was conducted in strict cooperation with many persons at Varian Medical Systems involved in the development of this novel technology. Among them we are particularly grateful for support and assistance to Martin Sabel and Yves Archambault for planning and to Jiri Bocanek for delivery issues. The Phase II randomised trial mentioned in the introduction is part of a Research Cooperation Agreement between TMH and Varian Medical Systems.
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