Dosimetric Comparison of 3D Conformal Radiotherapy (3D-CRT), Intensity-Modulated Radiotherapy (IMRT), and Volumetric-Modulated Arc Therapy (VMAT) in Cardiac-Sparing Whole Lung Irradiation

Ryohei Yamauchi; Shinobu Akiyama; Norifumi Mizuno; Takako Kobayashi; Tomoko Itazawa; Tomoyuki Masuda; Miki Hirano; Fumihiro Tomita; Yosuke Hosoya; Jiro Kawamori

doi:10.7759/cureus.51047

Dosimetric Comparison of 3D Conformal Radiotherapy (3D-CRT), Intensity-Modulated Radiotherapy (IMRT), and Volumetric-Modulated Arc Therapy (VMAT) in Cardiac-Sparing Whole Lung Irradiation

Cureus. 2023 Dec 24;15(12):e51047. doi: 10.7759/cureus.51047. eCollection 2023 Dec.

Affiliations

¹ Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, JPN.
² Department of Pediatrics, St. Luke's International Hospital, Tokyo, JPN.

Abstract

Introduction Whole lung irradiation (WLI) is used for the treatment of lung metastasis in Wilms tumor and Ewing sarcoma; however, cardiac complications are one of the concerns. We report the dosimetric advantages of WLI using volumetric-modulated arc therapy (VMAT) and present a dosimetric comparison of VMAT with anteroposterior-posteroanterior (AP-PA) and static-field intensity-modulated radiation therapy (IMRT). Additionally, we evaluated the dosimetric impact of respiratory motion and intra-fractional motion during VMAT treatment. Methods Seven patients were recruited in this study. AP-PA, IMRT, one-isocenter (1-IC) VMAT, and 2-IC VMAT were planned on the maximum inspiration and expiration CT, respectively. The prescribed dose was 15 Gy in 10 fractions. To determine the effects of respiratory motion, the CT series was replaced and the dose was evaluated while maintaining the beam information. To determine the effect of patient motion, perturbed dose calculations were performed using a two-IC VMAT. The perturbation doses were calculated by shifting only the IC of the one side beam by 3 mm or 5 mm in the right-to-left (RL) direction. Results The mean heart dose was 1467.0 cGy, 790.0 cGy, 764.2 cGy, and 738.4 cGy for AP-PA, IMRT, 1-IC VMAT, and 2-IC VMAT, respectively. When the expiration CT plan was recalculated with inspiration CT, D_max increased approximately by 8%. In the 2-IC VMAT plan, the D_50%, D_98%, and D_2% dose differences were within ±2%, even with a 5 mm IC shift. Conclusion We confirmed a significant dosimetric advantage of VMAT over other techniques. 2-IC VMAT should be considered an effective treatment option during irradiation for large target volumes.

Keywords: dosimetric comparison study; ewing sarcoma (es); intensity-modulated radiation therapy (imrt); lung metastasis; respiratory motion; volumetric-modulated arc therapy; whole lung irradiation (wli).