Report on planning comparison of VMAT, IMRT and helical tomotherapy for the ESCALOX-trial pre-study
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RESEARCH
Report on planning comparison of VMAT, IMRT and helical tomotherapy for the ESCALOX‑trial pre‑study Steffi U. Pigorsch1* , Severin Kampfer1, Markus Oechsner1, Michael C. Mayinger3, Petra Mozes1, Michal Devecka1, Kerstin K. Kessel1, Stephanie E. Combs1,2 and Jan J. Wilkens1
Abstract Background: The ESCALOX trial was designed as a multicenter, randomized prospective dose escalation study for head and neck cancer. Therefore, feasibility of treatment planning via different treatment planning systems (TPS) and radiotherapy (RT) techniques is essential. We hypothesized the comparability of dose distributions for simultaneous integrated boost (SIB) volumes respecting the constraints by different TPS and RT techniques. Methods: CT data sets of the first six patients (all male, mean age: 61.3 years) of the pre-study (up to 77 Gy) were used for comparison of IMRT, VMAT, and helical tomotherapy (HT). Oropharynx was the primary tumor location. Normalization of the three step SIB (77 Gy, 70 Gy, 56 Gy) was D95% = 77 Gy. Coverage (CVF), healthy tissue conformity index (HTCI), conformation number (CN), and dose homogeneity (HI) were compared for PTVs and conformation index (COIN) for parotids. Results: All RT techniques achieved good coverage. For SIB77Gy, CVF was best for IMRT and VMAT, HT achieved highest CN followed by VMAT and IMRT. HT reached good HTCI value, and HI compared to both other techniques. For SIB70Gy, CVF was best by IMRT. HTCI favored HT, consequently CN as well. HI was slightly better for HT. For SIB56Gy, CVF resulted comparably. Conformity favors VMAT as seen by HTCI and CN. Dmean of ipsilateral and contralateral parotids favor HT. Conclusion: Different TPS for dose escalation reliably achieved high plan quality. Despite the very good results of HT planning for coverage, conformity, and homogeneity, the TPS also achieved acceptable results for IMRT and VMAT. Trial registration ClinicalTrials.gov Identifier: NCT 01212354, EudraCT-No.: 2010-021139-15. ARO: ARO 14-01 Keywords: Dose escalation, Head and neck cancer, Combined chemoradiation therapy, RT planning comparison, IMRT, VMAT, Helical tomotherapy, SIB Background Head and neck cancer patients are treated by intensity modulated radiotherapy (IMRT) as standard of care in radiation oncology. Early in the era of IMRT application, *Correspondence: [email protected] 1 Department of Radiation Oncology, Technical University of Munich (TUM), School of Medicine, Klinikum Rechts Der Isar, Ismaninger Straße 22, 81675 Munich, Germany Full list of author information is available at the end of the article
the concept of the simultaneous integrated boost (SIB) was evaluated [1]. This boost technique creates a selective heterogeneous dose distribution in one target divided into subvolumes with the aim of better conformity [2]. Many results of planning comparisons using different treatment planning systems (TPS) and radiotherapy (RT) treatment concepts have been published for both head and neck as well as other cancer. Many of these used real
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