Volumetric-modulated arc therapy vs c-IMRT in esophageal cancer: A treatment planning comparison

doi:10.3748/wjg.v18.i37.5266

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Oct 7, 2012; 18(37): 5266-5275
Published online Oct 7, 2012. doi: 10.3748/wjg.v18.i37.5266

Table 4 Dosimetric comparison for organs at risk of conventional sliding window intensity-modulated radiotherapy and volumetric-modulated arc therapy in cervical and upper thoracic esophageal cancer, and in middle and lower thoracic esophageal cancer, mean value (range)

Organ	Variable	c-IMRT (5F, 7F, 9F)	VMAT (1A, 2A)	Relative reduction (%)	P < 0.05
In cervical and upper thoracic
Lung (Gy)	MLD¹	12.65 (12.38-13.04)	12.57 (12.35-12.79)	0.6	2A vs 7F, 9F; 1A vs 7F
	MLD²	14.35 (13.91-14.76)	13.94 (13.74-14.14)	2.9	2A vs 7F, 9F
	V5¹	48.52 (46.28-50.52)	51.20 (51.03-51.37)	-5.5	1A, 2A vs 5F, 7F
	V5²	61.53 (57.51-65.06)	66.25 (66.07-66.43)	-7.7	1A , 2A vs 5F, 7F
	V10¹	39.30 (37.41-41.58)	43.44 (43.23-43.65)	-10.5	1A , 2A vs 5F, 7F; 2A vs 9F
	V10²	48.17 (44.18-52.07)	54.25 (53.70-54.79)	-12.6	1A , 2A vs 5F, 7F, 9F
	V20¹	24.70 (23.93-25.16)	24.17 (23.08-25.26)	2.1	1A vs 5F
	V20²	25.58 (24.29-26.23)	22.85 (21.94-23.76)	10.7	NS
	V30¹	14.96 (14.42-15.33)	12.99 (12.99-12.99)	13.2	1A, 2A vs 5F, 7F, 9F
	V30²	14.52 (14.27-15.00)	12.01 (11.58-12.04)	17.3	1A, 2A vs 5F, 7F; 2A vs 9F
Heart (%)	V30¹	6.83 (5.7-7.41)	5.30 (4.57-5.62)	22.4	NS
	V30²	15.20 (13.62-16.96)	10.11 (9.98-10.24)	33.5	1A vs 7F, 9F, 2A
	V40¹	4.33 (3.55-5.08)	2.68 (2.45-2.91)	38.1	NS
	V40²	8.32 (7.00-10.33)	5.30 (5.08-5.22)	36	1A vs 5F, 7F, 9F; 2A vs 5F
	V50¹	2.62 (2.07-3.09)	1.44 (1.43-1.45)	45	NS
	V50²	4.33 (3.44-5.53)	2.63 (2.59-2.67)	39.3	NS
Spinal cord (Gy)	D_max¹	37.92 (37.53-38.32)	37.74 (37.31-38.17)	0.5	NS
	D_max²	37.85 (37.41-38.43)	38.41 (38.05-38.76)	-1.5	NS
Head of humerus	D_max¹	10.00 (5.97-17.59)	21.88 (20.80-22.95)	-118.8	1A , 2A vs 5F, 7F, 9F
(Gy)	D_max²	7.57 (6.47-9.61)	26.44 (26.35-26.52)	-249.3	1A , 2A vs 5F, 7F
	D_mean¹	3.24 (2.07-4.71)	12.27 (11.85-12.69)	-278.7	2A vs 5F, 7F, 9F, 1A
	D_mean²	2.89 (1.47-4.86)	15.26 (14.61-15.90)	-428	2A vs 5F, 7F, 9F, 1A
In middle and lower thoracic
Lung (Gy)	MLD³	15.03 (14.86-15.27)	15.38 (15.24-15.51)	-2.3	1A, 2A vs 5F, 7F
	MLD⁴	15.37 (15.01-15.81)	15.67 (15.51-15.82)	-2	1A vs 5F
	V5³	74.86 (71.00-79.05)	82.83 (82.72-82.93)	-10.6	1A, 2A vs 5F, 7F, 9F
	V5⁴	79.36 (72.43-85.85)	89.91 (89.77-90.04)	-13.3	1A, 2A vs 5F, 7F, 9F
	V10³	55.14 (52.64-58.66)	65.26 (64.75-65.76)	-18.4	1A, 2A vs 5F, 7F, 9F
	V10⁴	59.56 (54.27-64.76)	72.54 (72.04-73.03)	-21.8	1A, 2A vs 5F, 7F; 2A vs 9F
	V20³	24.39 (23.84-24.96)	23.05 (22.28-23.81)	5.5	2A vs 7F, 9F, 1A
	V20⁴	25.32 (24.48-26.66)	21.40 (20.69-22.11)	15.5	1A, 2A vs 5F
	V30³	12.64 (12.08-13.01)	10.97 (10.88-11.06)	13.2	1A,2A vs 5F, 7F; 2A vs 9F
	V30⁴	11.13 (10.55-12.20)	9.10 (8.58-9.62)	18.2	1A, 2A vs 5F, 7F; 2A vs 9F
Heart (%)	V30³	47.30 (46.61-48.20)	42.26 (40.72-43.79)	10.7	1A vs 5F, 7F, 9F
	V30⁴	72.16 (67.81-78.60)	56.55 (55.52-57.57)	21.6	1A vs 5F, 7F, 9F; 2A vs 5F
	V40³	26.89 (24.86-28.14)	22.84 (20.98-24.69)	15.1	1A vs 7F
	V40⁴	33.53 (30.63-38.19)	26.27 (26.21-26.32)	21.7	2A vs 5F
	V50³	14.06 (12.50-16.06)	9.89 (8.93-10.85)	29.7	1A vs 5F, 7F, 9F
	V50⁴	17.99 (14.48-22.87)	11.16 (10.93-11.39)	38	1A, 2A vs 5F; 2A vs 7F, 9F
Spinal cord (Gy)	D_max³	39.03 (38.91-39.15)	38.70 (38.54-38.86)	0.8	NS
	D_max⁴	37.61 (37.45-37.91)	37.99 (37.78-38.20)	-1	NS

Wilcoxon’s signed ranks test.

¹Cervical thoracic esophageal cancer;

²upper thoracic esophageal cancer;

³middle thoracic esophageal cancer;

⁴lower thoracic esophageal cancer. c-IMRT: Conventional sliding window intensity-modulated radiotherapy; VMAT: Volumetric-modulated arc therapy; MLD: Mean dose of lungs; D_max: Maximal dose; D_mean: Mean dose; F: Coplanar field; A: Arc; V_X: The percentage of organ receiving a dose > X Gy; NS: Not significant.

Citation: Yin L, Wu H, Gong J, Geng JH, Jiang F, Shi AH, Yu R, Li YH, Han SK, Xu B, Zhu GY. Volumetric-modulated arc therapy vs c-IMRT in esophageal cancer: A treatment planning comparison. World J Gastroenterol 2012; 18(37): 5266-5275
URL: https://www.wjgnet.com/1007-9327/full/v18/i37/5266.htm
DOI: https://dx.doi.org/10.3748/wjg.v18.i37.5266