{"title":"Assessment of Organ-at-risk Sparing in Esophageal Cancer: A Comparative Dosimetric Evaluation of Hybrid, Noncoplanar, and Coplanar RapidArc Plans.","authors":"Mukesh Kumar Zope, Deepali Bhaskar Patil, Dinesh Kumar Saroj","doi":"10.4103/jmp.jmp_63_24","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>The purpose of this study is to improve the precision of radiation treatment and sparing of organ-at-risk (OAR) in patients with thoracic esophageal cancer (EC) affecting the heart, lung, and spinal cord. To improve and personalize cancer treatment plans, it assesses the dosimetric benefits of coplanar RapidArc (RA<sub>c</sub>), hybrid arc (RA<sub>Hyb</sub>), and noncoplanar RapidArc (RA<sub>nc</sub>).</p><p><strong>Materials and methods: </strong>Fourteen patients with EC were chosen for our investigation from our hospital's database. RapidArc (RA) plan patients had already received treatment. Retrospectively, additional RA<sub>nc</sub> and RA<sub>Hyb</sub> plans were made with a prescription dose of 50.4 Gy in 28 fractions for the planning target volume (PTV). A prescription dose of 95% of PTV was used, so that three different treatment planning procedures could be compared. The cumulative dose-volume histogram was used to analyze the plan quality indices homogeneity index (HI), conformity index (CI), conformation number (CN) as well as the OARs doses to the lung, heart, and spinal cord.</p><p><strong>Results: </strong>In comparison to RA<sub>c</sub> and RA<sub>nc</sub> techniques, the study indicated that RA<sub>Hyb</sub> plans significantly increased D95%, CI and HI; Dmax and CN did not differ substantially. In addition, compared to RA<sub>c</sub> (lung: 16.15 ± 0.03 Gy and heart: 23.91 ± 4.67 Gy) and RA<sub>nc</sub> (lung: 15.24 ± 0.03 Gy and heart 23.82 ± 5.10 Gy) plans, RA<sub>Hyb</sub> resulted in significantly lower mean lung doses (15.10 ± 0.03 Gy) and heart doses (21.33 ± 6.99 Gy). Moreover, the RA<sub>Hyb</sub> strategy showed a statistically significant (<i>P</i> < 0.05) lower average MU (452.7) than both the RA<sub>c</sub> (517.5) and RA<sub>nc</sub> (566.2) plans.</p><p><strong>Conclusion: </strong>The D95%, conformity, and homogeneity indices were better for hybrid arc plans compared to RA<sub>c</sub> and RA<sub>nc</sub> plans. They also successfully managed to reduce the lung and heart doses as well as the mean MU per fraction.</p>","PeriodicalId":51719,"journal":{"name":"Journal of Medical Physics","volume":"49 3","pages":"419-426"},"PeriodicalIF":0.7000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548063/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Medical Physics","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/jmp.jmp_63_24","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/21 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
Abstract
Aim: The purpose of this study is to improve the precision of radiation treatment and sparing of organ-at-risk (OAR) in patients with thoracic esophageal cancer (EC) affecting the heart, lung, and spinal cord. To improve and personalize cancer treatment plans, it assesses the dosimetric benefits of coplanar RapidArc (RAc), hybrid arc (RAHyb), and noncoplanar RapidArc (RAnc).
Materials and methods: Fourteen patients with EC were chosen for our investigation from our hospital's database. RapidArc (RA) plan patients had already received treatment. Retrospectively, additional RAnc and RAHyb plans were made with a prescription dose of 50.4 Gy in 28 fractions for the planning target volume (PTV). A prescription dose of 95% of PTV was used, so that three different treatment planning procedures could be compared. The cumulative dose-volume histogram was used to analyze the plan quality indices homogeneity index (HI), conformity index (CI), conformation number (CN) as well as the OARs doses to the lung, heart, and spinal cord.
Results: In comparison to RAc and RAnc techniques, the study indicated that RAHyb plans significantly increased D95%, CI and HI; Dmax and CN did not differ substantially. In addition, compared to RAc (lung: 16.15 ± 0.03 Gy and heart: 23.91 ± 4.67 Gy) and RAnc (lung: 15.24 ± 0.03 Gy and heart 23.82 ± 5.10 Gy) plans, RAHyb resulted in significantly lower mean lung doses (15.10 ± 0.03 Gy) and heart doses (21.33 ± 6.99 Gy). Moreover, the RAHyb strategy showed a statistically significant (P < 0.05) lower average MU (452.7) than both the RAc (517.5) and RAnc (566.2) plans.
Conclusion: The D95%, conformity, and homogeneity indices were better for hybrid arc plans compared to RAc and RAnc plans. They also successfully managed to reduce the lung and heart doses as well as the mean MU per fraction.
期刊介绍：
JOURNAL OF MEDICAL PHYSICS is the official journal of Association of Medical Physicists of India (AMPI). The association has been bringing out a quarterly publication since 1976. Till the end of 1993, it was known as Medical Physics Bulletin, which then became Journal of Medical Physics. The main objective of the Journal is to serve as a vehicle of communication to highlight all aspects of the practice of medical radiation physics. The areas covered include all aspects of the application of radiation physics to biological sciences, radiotherapy, radiodiagnosis, nuclear medicine, dosimetry and radiation protection. Papers / manuscripts dealing with the aspects of physics related to cancer therapy / radiobiology also fall within the scope of the journal.
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