A dosimetric study of volumetric modulated arc therapy with a simultaneous integrated boost for preoperative chemoradiotherapy in patients with locally advanced rectal cancer
Liu Qiteng,Han Qian,WangYunlai,Yang Tao,Chen Jing,Wen Ke,Zeng Mingyue,Wang Jinyuan,Cong Xiaohu,Feng Linchun
Department of Radiation Oncology (Liu QT,Wang YL,Yang T,Chen J,Wang JY,Cong XH,Feng LC),Chinese PLA General Hospital,Beijing 100853,China;Department of Oncology,Henan Provincial People′s Hospital,People′s Hospital of Zhengzhou University,Zhengzhou 450008,China (Han Q);Department of Radiation Oncology,Chinese PLA 302 Hospital,Beijing 100039,China (Wen K);Department of Radiation Oncology,Hainan Branch of Chinese PLA 301 Hospital,Sanya 572013,China (Zeng MY)
Objective To investigate the dosimetric feasibility of volumetric modulated arc therapy (VMAT) with a simultaneous integrated boost (SIB-VMAT58.75 Gy) for preoperative chemoradiotherapy inpatients with locally advanced rectal cancer (LARC),and to provide a basis for clinical practice. MethodsNine patients with stage Ⅱ-Ⅲ rectal cancer who underwent preoperative concurrent chemoradiotherapy were involved in the study,and two plans were performed for each patient:SIB-VMAT58.75 Gy and VMAT50.00 Gy. For the SIB-VMAT58.75 Gy plan,the prescribed dose was 58.75 Gy (2.35 Gy/fraction) for the local rectal tumor and positive lymph nodes (GTV 58.75 Gy),and 50 Gy (2 Gy/fraction) for the regions at high risk of harboring microscopic disease (pelvic lymphatic drainage area)(PTV50 Gy).For the VMAT50.00 Gy plan,the prescribed dose was 50 Gy (2 Gy/fraction) for the regions at high risk of harboring microscopic disease (pelvic lymphatic drainage area) without a boost. The conformity index (CI),homogeneity index (HI),and dose for target areas and organs at risk (OAR) were assessed according to the dose-volume histogram. The paired t-test or nonparametric rank test was used to compare the differences between the two plans. Resutls Both plans met the prescription goal for PTV dose coverage. There was no significant difference in CI for the PTV between the two plans (1.0±0.0 vs. 1.0±0.0,P>0.05).The SIB-VMAT58.75 Gy plan had a worse HI than the VMAT50.00 Gy plan (0.2±0.2 vs. 0.1±0.0,P<0.05).There was no significant difference in V10-V50 of the small intestine,bladder,femoral heads,and pelvis between the two plans (P>0.05),but D2 cm3 of the small intestine was significantly higher in the SIB-VMAT58.75 Gy plan than in the VMAT50.00 Gy plan (P=0.038). Conclutions The SIB-VMAT58.75 Gy plan for LARC achieves required target volume dose coverage and OAR dose constraints,which is safe and feasible in terms of dosimetry,and its clinical efficacy and adverse effects need further evaluation.
Liu Qiteng,Han Qian,WangYunlai et al. A dosimetric study of volumetric modulated arc therapy with a simultaneous integrated boost for preoperative chemoradiotherapy in patients with locally advanced rectal cancer[J]. Chinese Journal of Radiation Oncology, 2017, 26(11): 1313-1317.
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