Physics Contribution Volumetric Intensity-modulatedarc Therapy vs. Conventional Imrt in Head-and-neck Cancer: a Comparative Planning and Dosimetric Study

Purpose: Volumetric intensity-modulated arc therapy (RA) allows for rapid delivery of highly conformal dose distributions. In this study, planning and dosimetry of RAwere compared with conventional intensity-modulated radiation therapy (IMRT) plans of head-and-neck cancer patients. Materials and Methods: Computed tomography scans of 12 patients who had completed IMRT for advanced tumors of the naso-, oroand hypopharynxwere replanned using RAusing either one or two arcs. Calculated doses to planning target volume (PTV) and organs at risk (OAR) were compared between IMRT and RA plans. Dose distributions for single arc (n = 8) and double arc (n = 4) plans were verified using film dosimetry in three to five coronal planes using a quality assurance phantom. Results: RA plans allowed for a mean reduction in number of monitor units (MU) by nearly 60%, relative to seven field sliding window IMRT plans. RA plans achieved similar sparing of all OAR as IMRT. Double arc RA provided the best dose homogeneity to PTV with a lower standard deviation of PTV dose (1.4 Gy), vs. single arc plans (2.0 Gy) and IMRT (1.7 Gy). Filmmeasurements showed good correspondence with calculated doses; themean gamma value was 0.30 (double arc) and area of the film with a gamma exceeding 1 was 0.82%. Conclusions: RA is a fast, safe, and accurate technique that uses lower MUs than conventional IMRT. Double arc plans provided at least similar sparing of OAR and better PTV dose homogeneity than single arc or IMRT. ! 2009 Elsevier Inc.