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Intensity-modulated radiation therapy versus volumetric-modulated arc therapy in non-small cell lung cancer: assessing the risk of radiation pneumonitis

Published online by Cambridge University Press:  06 June 2017

Sara Rosas ,
Bárbara Barbosa  and
José G. Couto
Sara Rosas*
Affiliation:
Radiotherapy Department, Escola Superior de Tecnologia da Saúde do Porto, Rua Valente Perfeito, Vila Nova de Gaia, Portugal
Bárbara Barbosa
Affiliation:
Radiotherapy Department, Escola Superior de Tecnologia da Saúde do Porto, Rua Valente Perfeito, Vila Nova de Gaia, Portugal Radiotherapy Department, Instituto Português de Oncologia do Porto, Rua Doutor António Bernardino de Almeida, Porto, Portugal
José G. Couto
Affiliation:
Radiotherapy Department, Escola Superior de Tecnologia da Saúde do Porto, Rua Valente Perfeito, Vila Nova de Gaia, Portugal Radiotherapy Department, Instituto Português de Oncologia do Porto, Rua Doutor António Bernardino de Almeida, Porto, Portugal
*
Correspondence to: Sara Rosas, Paul Scherrer Institut, WPTA/139, 5232 Villigen PSI, Switzerland. Tel: +41 56 310 56 13. E-mail: Sara.Rosas@psi.ch
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Abstract

Purpose

This study aimed to compare intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) regarding plan quality and healthy lung sparing, in stage III non-small cell lung cancer (NSCLC) patients.

Materials and methods

The plans of 60 patients were allocated either to the IMRT (n=30) or the VMAT (n=30) group. The dose prescribed to the planning target volume (PTV) was evaluated at the 95% level and the mean lung dose (MLD) and the healthy lung receiving 5, 10 and 20 Gy (V5, V10 and V20, respectively) were analysed. The normal tissue complication probability (NTCP) for radiation pneumonitis was calculated with the Lyman–Kutcher–Burman model.

Results

Both techniques achieved comparable results for target coverage (V95%=97·87 versus 97·18%, p>0·05) and homogeneity. The MLD (15·57 versus 16·98 Gy, p>0·05), V5 (60·35 versus 67·25%, p>0·05) and V10 (45·22 versus 53·14%, p=0·011) were lower for IMRT, whereas VMAT reduced V20 (26·44 versus 25·90%, p>0·05). The NTCP for radiation pneumonitis was higher for VMAT, but no statistical significance was observed (11·07 versus 12·75, p>0·05).

Conclusion

Both techniques seemed suitable for NSCLC treatment, but IMRT presented better results regarding lung sparing thus being beneficial in reducing the risk of radiation-induced pneumonitis.

Keywords

IMRTNSCLCNTCPradiation pneumonitisVMAT
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 17 , Issue 1 , March 2018 , pp. 6 - 11
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Copyright
© Cambridge University Press 2017 

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References

1. Yun, F, Jia, Y, Li, X et al. Clinicopathological significance of PTEN and PI3K/AKT signal transduction pathway in non-small cell lung cancer. Int J Clin Exp Pathol 2013; 6 (10): 2112–2120.Google Scholar
2. Zhao, N, Yang, R, Wang, J, Zhang, X, Li, J. An IMRT/VMAT technique for nonsmall cell lung cancer. Biomed Res Int 2015; 2015: 613060.Google Scholar
3. Zhang, J, Yu, X L, Zheng, G F, Zhao, F. Intensity-modulated radiotherapy and volumetric-modulated arc therapy have distinct clinical advantages in non-small cell lung cancer treatment. Med Oncol 2015; 32 (4): 94.Google Scholar
4. Rana, S. Intensity modulated radiation therapy versus volumetric intensity modulated arc therapy. J Med Radiat Sci 2013; 60 (3): 81–83.CrossRefGoogle ScholarPubMed
5. Rao, M, Yang, W, Chen, F et al. Comparison of Elekta VMAT with helical tomotherapy and fixed field IMRT: plan quality, delivery efficiency and accuracy. Med Phys 2010; 37 (3): 1350–1359.Google Scholar
6. Bertelsen, A, Hansen, O, Brink, C. Does VMAT for treatment of NSCLC patients increase the risk of pneumonitis compared to IMRT? – a planning study. Acta Oncol 2012; 51 (6): 752–758.Google Scholar
7. Wijsman, R, Dankers, F et al. Comparison of toxicity and outcome in advanced stage non-small cell lung cancer patients treated with intensity-modulated (chemo-)radiotherapy using IMRT or VMAT. Radiother Oncol 2016; 122 (2): 295–299.Google Scholar
8. Jiang, X, Li, T, Liu, Y et al. Planning analysis for locally advanced lung cancer: dosimetric and efficiency comparisons between intensity-modulated radiotherapy (IMRT), single-arc/partial-arc volumetric modulated arc therapy (SA/PA-VMAT). Radiat Oncol 2011; 6: 140.Google Scholar
9. Holt, A, van Vliet-Vroegindeweij, C, Mans, A, Belderbos, J S, Damen, E M. Volumetric-modulated arc therapy for stereotactic body radiotherapy of lung tumors: a comparison with intensity-modulated radiotherapy techniques. Int J Radiat Oncol Biol Phys 2011; 81 (5): 1560–1567.Google Scholar
10. Shi, A, Zhu, G, Wu, H, Yu, R, Li, F, Xu, B. Analysis of clinical and dosimetric factors associated with severe acute radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with concurrent chemotherapy and intensity-modulated radiotherapy. Radiat Oncol 2010; 5: 35.Google Scholar
11. ICRU REPORT 83. Prescribing, recording and reporting photon-beam IMRT. Journal of the ICRU 2010; 10 (1): 1–106.CrossRefGoogle Scholar
12. Hedin, E, Back, A. Influence of different dose calculation algorithms on the estimate of NTCP for lung complications. J Appl Clin Med Phys 2013; 14 (5): 127–139.CrossRefGoogle ScholarPubMed
13. Seppenwoolde, Y, Lebesque, J V, de Jaeger, K et al. Comparing different NTCP models that predict the incidence of radiation pneumonitis. Normal tissue complication probability. Int J Radiat Oncol Biol Phys 2003; 55 (3): 724–735.CrossRefGoogle ScholarPubMed
14. Wennberg, B M, Baumann, P, Gagliardi, G et al. NTCP modelling of lung toxicity after SBRT comparing the universal survival curve and the linear quadratic model for fractionation correction. Acta Oncol 2011; 50 (4): 518–527.Google Scholar
15. Niemierko, A. Reporting and analyzing dose distributions: a concept of equivalent uniform dose. Med Phys 1997; 24 (1): 103–110.Google Scholar
16. Gulliford, S L, Partridge, M, Sydes, M R, Webb, S, Evans, P M, Dearnaley, D P. Parameters for the Lyman Kutcher Burman (LKB) model of normal tissue complication probability (NTCP) for specific rectal complications observed in clinical practise. Radiother Oncol 2012; 102 (3): 347–351.CrossRefGoogle ScholarPubMed
17. Uzan, J, Nahum, A E. Radiobiologically guided optimisation of the prescription dose and fractionation scheme in radiotherapy using BioSuite. Br J Radiol 2012; 85 (1017): 1279–1286.Google Scholar
18. Bufacchi, A, Nardiello, B, Capparella, R, Begnozzi, L. Clinical implications in the use of the PBC algorithm versus the AAA by comparison of different NTCP models/parameters. Radiat Oncol 2013; 8 (1): 164.Google Scholar
19. Wedenberg, M. From Cell Survival to Dose Response – Modelling Biological Effects in Radiation Therapy. Stockholm, Sweden: Karolinska Institutet, 2013.Google Scholar
20. Tesfamicael, B. Volumetric modulated radiation therapy and intensity modulated radiation therapy for lung cancer: literature review. J Cancer Res Treat 2013; 1 (2): 39–41.Google Scholar
21. Verbakel, W F, van Reij, E, Ladenius-Lischer, I, Cuijpers, J P, Slotman, B J, Senan, S. Clinical application of a novel hybrid intensity-modulated radiotherapy technique for stage III lung cancer and dosimetric comparison with four other techniques. Int J Radiat Oncol Biol Phys 2012; 83 (2): e297–e303.Google Scholar