Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-27T09:16:36.320Z Has data issue: false hasContentIssue false
  • English
  • Français

Dosimetric comparison of 3-dimensional conformal radiotherapy (3D-CRT) and volumetric-modulated arc therapy (VMAT) in locally advanced cancer cervix

Published online by Cambridge University Press:  06 October 2020

Animesh Agrawal ,
Rahat Hadi Open the ORCID record for Rahat Hadi [Opens in a new window] ,
Satyajeet Rath Open the ORCID record for Satyajeet Rath [Opens in a new window] ,
Avinav Bharati ,
Madhup Rastogi ,
Rohini Khurana ,
Kamal Sahni ,
Shantanu Sapru ,
Ajeet Kumar Gandhi  and
Anoop Kumar Srivastava
...Show all authors
Animesh Agrawal
Affiliation:
Department of Medical Oncology, Gujarat Cancer Research Institute, Ahmedabad, India
Rahat Hadi*
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Satyajeet Rath
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Avinav Bharati
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Madhup Rastogi
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Rohini Khurana
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Kamal Sahni
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Shantanu Sapru
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Ajeet Kumar Gandhi
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Anoop Kumar Srivastava
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Surendra Prasad Mishra
Affiliation:
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
*
Author for correspondence: Rahat Hadi, Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India. Tel: 8858826619. E-mail: drrahathadi@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Dosimetric advantages of volumetric-modulated arc therapy (VMAT) over three-dimensional conformal radiotherapy (3D-CRT) are not established in a head-on comparison of a uniform group of locally advanced carcinoma of the cervix (LACC). Therefore, we conducted a dosimetric comparison of these two techniques in LACC patients.

Materials and methods:

Computed tomography (CT) data of histologically proven de novo LACC, including Stage IIB–IIIB and earlier stages deemed inoperable, were included in this prospective observational dosimetric study. Planning was initially done by 3D-CRT technique (dose of 45–50·4 Gy @ 1·8–2 Gy/# was used in the actual treatment), followed by VMAT planning and appropriate dosimetric comparisons were done in 39 cases.

Results:

For planning target volume coverage, D95, D98 and D100 (p < 0·0001 for all parameters) and V95 and V100 (p = 0·002 and <0·0001, respectively) were significantly improved with VMAT. The conformity index (CI) was significantly better with VMAT (p = 0·03), while 3D-CRT had a significantly better homogeneity index (HI)(p = 0·003). Dose to the urinary bladder was significantly reduced with VMAT compared to 3D-CRT for V20–V50, except V10. The doses to the rectum and abdominal cavity were significantly reduced with VMAT compared to 3D-CRT plans for all parameters (V10–V50). The number of organs at risks (OARs) for which constraints were met was higher with VMAT plans than with 3D-CRT plans, with at least four out of the five OARs protected in 46·1 versus 5·1% and all constraints achieved in 15·4% versus none.

Conclusion:

We conclude that in dosimetric terms, VMAT is superior to 3D-CRT for LACC.

Keywords

carcinoma cervixdosimetryVMAT3D-CRTLACC
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 1 , March 2022 , pp. 60 - 67
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ferlay, J, Soerjomataram, I, Dikshit, R et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136 (5): E359–E386.Google Scholar
Nandakumar, A, Anantha, N, Venugopal, TC. Incidence, mortality and survival in cancer of the cervix in Bangalore, India. Br J Cancer 1995; 71 (6): 1348–1352. 10.1038/bjc.1995.262CrossRefGoogle ScholarPubMed
Peters, W A 3rd, Liu, P Y, Barrett, RJ 2nd et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 2000; 18 (8): 1606–1613. 10.1200/JCO.2000.18.8.1606CrossRefGoogle ScholarPubMed
Mundt, A J, Mell, L K, Roeske, J C. Preliminary analysis of chronic gastrointestinal toxicity in gynecology patients treated with intensity-modulated whole pelvic radiation therapy. Int J Radiat Oncol Biol Phys 2003; 56:1354–1360. CrossRefGoogle ScholarPubMed
Mell, L K, Tiryaki, H, Ahn, K H et al. Dosimetric comparison of bone marrow-sparing intensity-modulated radiotherapy versus conventional techniques for treatment of cervical cancer. Int J Radiat Oncol Biol Phys 2008; 71:1504–1510. 10.1016/j.ijrobp.2008.04.046CrossRefGoogle ScholarPubMed
Teoh, M, Clark, C H, Wood, K et al. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol 2011; 84 (1007): 967–996. CrossRefGoogle ScholarPubMed
Lukovic, J, Patil, N, D’souza, D et al. Intensity-modulated radiation therapy versus 3D conformal radiotherapy for postoperative gynecologic cancer: are they covering the same planning target volume? Cureus 2016; 8 (1): e467. Google ScholarPubMed
Otto, K. Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys 2008; 35:310–317. CrossRefGoogle Scholar
Palma, D, Vollans, E, James, K et al. Volumetric modulated arc therapy for delivery of prostate radiotherapy: comparison with intensity- modulated radiotherapy and three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 2008; 72 (4): 996–1001. CrossRefGoogle ScholarPubMed
Richetti, A, Fogliata, A, Clivio, A et al. Neoadjuvant chemoradiation of rectal cancer with volumetric modulated arc therapy: summary of technical and dosimetric features and early clinical experience. Radiat Oncol 2010; 5:14. 10.1186/1748-717X-5-14CrossRefGoogle ScholarPubMed
Cozzi, L, Dinshaw, K A, Shrivastava, S K et al. A treatment planning study comparing volumetric arc modulation with RapidArc and fixed field IMRT for cervix uteri radiotherapy. Radiother Oncol 2008; 89 (2): 180–191. 10.1016/j.radonc.2008.06.013CrossRefGoogle ScholarPubMed
Teoh, M, Clark, C H, Wood, K et al. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol 2011; 84:967–996. CrossRefGoogle ScholarPubMed
Yang, B, Zhu, L, Cheng, H et al. Dosimetric comparison of intensity modulated radiotherapy and three-dimensional conformal radiotherapy in patients with gynecologic malignancies: a systematic review and meta-analysis. Radiat Oncol 2012; 7:197. 10.1186/1748-717X-7-197CrossRefGoogle ScholarPubMed
Pecorelli, S, Zigliani, L, Odicino, F. Revised FIGO staging for carcinoma of the cervix. Int J Gynaecol Obstet 2009; 105 (2): 107–108.CrossRefGoogle ScholarPubMed
International Commission on Radiation Units and Measurements. Report 50: Prescribing, Recording, and Reporting Photon Beam Therapy. Bethesda, MD: International Commission on Radiation Units and Measurements, 1993.Google Scholar
International Commission on Radiation Units and Measurements. Report 62: Prescribing, Recording, and Reporting Photon Beam Therapy (Supplement to ICRU Report 50). Bethesda, MD: International Commission on Radiation Units and Measurements, 1999.Google Scholar
ICRU. Report 83: prescribing, recording, and reporting photon-beam intensity-modulated radiation therapy (IMRT). J ICRU 2010; 10 (1): 1–106.10.1093/jicru_ndq002CrossRefGoogle Scholar
Taylor, A, Rockall, A G, Reznek, R H et al. Mapping pelvic lymph nodes: guidelines for delineation in intensity-modulated radiotherapy. Int J Rad Onc Biol Phys 2005; 63 (5): 1604–1612.CrossRefGoogle ScholarPubMed
Lim, K, Small, W, Portelance, L et al. Consensus guidelines for delineation of clinicaltarget volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer. Int J Rad Onc Biol Phys 2011; 79 (2): 348–355.CrossRefGoogle Scholar
Bansal, A, Patel, F D, Rai, B et al. Literature review with PGI guidelines for delineation of clinical target volume for intact carcinoma cervix. J Can Res Ther 2013; 9 (4): 574–582.Google ScholarPubMed
Small, W, Mell, L K, Anderson, P et al. Consensus guidelines for the delineation of the clinical target volume for intensity modulated pelvic radiotherapy in the postoperative treatment of endometrial and cervical cancer. Int J Rad Oncol, Biol, Phys 2008; 71 (2): 428–434.CrossRefGoogle ScholarPubMed
Feuvret, L, Noël, G, Mazeron, J J et al. Conformity index: a review. Int J Radiat Oncol Biol Phys 2006; 64 (2): 333–342. 10.1016/j.ijrobp.2005.09.028CrossRefGoogle ScholarPubMed
Lee, J E, Han, Y, Huh, S J et al. Interfractional variation of uterine position during radical RT: weekly CT evaluation. Gynecol Oncol 2007; 104: 145–151.10.1016/j.ygyno.2006.07.009CrossRefGoogle ScholarPubMed
Beadle, B, Jhingran, A, Salehpour, M et al. Cervix regression and motion during the course of external beam chemoradiation for cervical cancer. Int J Radiat Onc Biol Phys 2009; 73 (1): 235–241.CrossRefGoogle ScholarPubMed
Buchali, A, Koswig, S, Dinges, S et al. Impact of the filling status of the bladder and rectum on their integral dose distribution and the movement of the uterus in the treatment planning of gynaecological cancer. Radiother Oncol 1999; 52: 29–34.CrossRefGoogle ScholarPubMed
Lee, C M, Shrieve, D C, Gaffney, D K. Rapid involution and mobility of carcinoma of the cervix. Int J Radiat Oncol Biol Phys 2004; 58:625–630.10.1016/j.ijrobp.2003.09.060CrossRefGoogle ScholarPubMed
Chan, P, Dinniwell, R, Haider, MA et al. Inter- and intrafractional tumor and organ movement in patients with cervical cancer undergoing radiotherapy: a cinematic-MRI point-of-interest study. Int J Radiat Oncol Biol Phys 2008; 70: 1507–1515.CrossRefGoogle ScholarPubMed
Taylor, A, Powell, M E. An assessment of interfractional uterine and cervical motion: implications for radiotherapy target volume definition Ingynaecological cancer. Radiother Oncol 2008; 88: 250–257.CrossRefGoogle ScholarPubMed
Chen, W-Z, Xiao, Y, Li, J. Impact of dose calculation algorithm on radiation therapy. World J Radiol 2014; 6 (11): 874–880.10.4329/wjr.v6.i11.874CrossRefGoogle ScholarPubMed
Rana, S. Intensity modulated radiation therapy versus volumetric intensity modulated arc therapy. J Med Rad Sci 2013; 60 (3): 81–83.10.1002/jmrs.19CrossRefGoogle ScholarPubMed