Volumetric modulated arc therapy (VMAT) comparison to 3D-conformal technique in lung stereotactic ablative radiotherapy (SABR)
J Med Radiat Sci. 2022 Nov 24. doi: 10.1002/jmrs.634. Online ahead of print.
Frances Mark 1 2 , Anoud Alnsour 3 , Scott N Penfold 4 5 6 , Adrian Esterman 7 , Robert Keys 1 , Hien Le 1 4 7
1 Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
2 Oncology Department, Plymouth Hospitals Trust, Plymouth, UK.
3 King Hussein Cancer Center -KHCC, Amman, Jordan.
4 Australian Bragg Centre for Proton Therapy and Research, Adelaide, South Australia, Australia.
5 Department of Physics, University of Adelaide, Adelaide, South Australia, Australia.
6 SAHMRI, Adelaide, South Australia, Australia.
7 Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
DOI: 10.1002/jmrs.634
Introduction: Stereotactic ablative radiotherapy (SABR) can be a curative option for non-small cell lung cancer (NSCLC) and oligometastatic lung disease. Volumetric modulated arc therapy (VMAT) has offered further advancements in terms of radiation dose shaping without compromising treatment times however there is potential for greater low-dose exposure to the lung. This study was to assess whether VMAT lung SABR would result in any increase to the dosimetry parameters compared with three-dimensional conformal radiotherapy (3D-CRT) that could confer increased risk of radiation pneumonitis.
Methods: A total of 53 and 30 3D-CRT treatment plans of patients treated with 48 Gy in 4 fractions were compared.
Results: No statistically significant difference in planning target volumes between the VMAT 29.9 cc (range 12.4-58.5 cc) and 3D-CRT 31.2 cc (range 12.3-58.3 cc) P = 0.79. The mean of total lung V5, ipsilateral lung V5 and contralateral lung V5 all showed a trend of being smaller in the VMAT treatment group- 14% versus 15.8%, 25.6% versus 30.4% and 1.6% versus 2.2%, respectively, but all were not statistically significant differences. Mean of the mean lung dose MLD, again showed a trend of being lower in the VMAT treatments but was also non-significant, 2.6 Gy versus 3.0 Gy, P = 1.0. Mean V20 was the same in both cohorts, 3.3%.
Conclusions: The dosimetry for 3D-CRT and VMAT plans were not significantly different including V5, and therefore we conclude that VMAT treatment is unlikely to be associated with an increased risk of radiation pneumonitis.
Keywords: Non-small cell lung cancer; V5; radiation pneumonitis; stereotactic ablative radiotherapy; volumetric modulated arc therapy.
© 2022 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.