Purpose Volumetric intensity-modulated arc therapy (RA) allows for rapid delivery of highly conformal dose distributions. In this study, planning and dosimetry of RA were 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-, oro- and hypopharynx were replanned using RA using 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). Film measurements showed good correspondence with calculated doses; the mean 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.

Volumetric intensity-modulated arc therapy vs. conventional IMRT in head-and-neck cancer: a comparative planning and dosimetric study.

Purpose To evaluate volumetric modulated arc radiotherapy (RapidArc [RA]), a novel approach allowing for rapid treatment delivery, for the treatment of vestibular schwannoma (VS). Methods and Materials The RA plans were generated for a small (0.5 cm 3 ), intermediate (2.8 cm 3 ), and large (14.8 cm 3 ) VS. The prescription dose was 12.5 Gy to the encompassing 80% isodose. The RA plans were compared with conventional radiosurgery plans using both a single dynamic conformal arc (1DCA) and five noncoplanar dynamic conformal arcs (5DCA). Conformity indices (CI) and dose–volume histograms of critical organs were compared. The RA plan for the medium-sized VS was measured in a phantom using Gafchromic EBT films and compared with calculated dose distributions. Results The RA planning was completed within 30 min in all cases, and calculated treatment delivery time (after patient setup) was 5 min vs. 20 min for 5DCA. A superior CI was achieved with RA, with a substantial decrease in low-dose irradiation of the normal brain achieved relative to 5DCA plans. Maximum doses to critical organs were similar for RA and 5DCA but were higher for 1DCA. Film measurements showed the differences between calculated and measured doses to be smaller than 1.5% in the high-dose area and smaller than 3% in the low-dose area. Conclusion The RA plans consistently achieved a higher CI and decrease in areas of low-dose irradiation. This, together with shorter treatment delivery times, has led to RA replacing our conventional five-arc radiosurgery technique for VS.

Volumetric modulated arc radiotherapy for vestibular schwannomas.

We read with interest the article titled 'Single-Arc IMRT?' (Bortfeld and Webb 2009 Phys. Med. Biol. 54 N9-20) and feel it imperative to draw the attention of your readers to comments suggesting that the authors may not be fully aware of current developments in this field. As their paper was first submitted on 19th of August 2008, it could not have taken into account data presented at the AAPM, ESTRO and ASTRO meetings in 2008. In this letter, we would like to clarify some relevant aspects of RapidArc (Varian Medical Systems) as a modality for delivering single-arc treatment.

Comments on 'Single-Arc IMRT?'.

Rapid delivery of stereotactic radiotherapy for peripheral lung tumors using volumetric intensity-modulated arcs

Purpose: To compare calculated and delivered dose distributions from RapidArc™ (a form of volumetric modulated arc therapy, Varian Medical Systems). RapidArc is a novel approach for delivering single arc therapy in less than 2 minutes, while achieving dose distributions comparable to current IMRT. We report the first detailed dosimetric validation for 5 different tumour sites with RapidArc plans. Method and Materials: Clinical RapidArc plans were generated with a pre‐clinical version for single cases with glioblastoma multiforme, multiple brain metastases, nasopharynx‐, oropharynx‐ and pancreas carcinoma. All five plans were delivered with a Varian Linac and measured in a solid water phantom for 5 coronal planes, 2 cm separated, using double Gafchromic®EBT films. Plans were also measured using ionisation chamber arrays (MatriXX). Measured and calculated dose distributions were compared using 2D gamma evaluation with limits of 2mm and 3.5% (of typical PTV dose in phantom). Results: All 25 film measurements showed high agreement with calculations, with a mean gamma of 0.29 and on average 1% (maximum 3%) of the film surface exceeding a gamma of 1.0. Relatively strong spatial dose modulations could be measured, within 95–107% dose range in the PTV, which were not completely predicted by calculations. This could lead to local dose changes >3% when changing a plane by 2mm. MatriXX measurements corresponded better with dose calculations than film measurements, which may be due to the limited resolution of 7.6mm of MatriXX. Conclusion: RapidArc accurately delivers the planned dose distributions. Film measurements may be preferred for dosimetric verification as more dose modulation is detectable than with ionisation array measurements. A “2.5D” gamma evaluation taking into account multiple adjacent dose planes would show better agreement for film dosimetry. Our results indicate that RapidArc can be introduced into clinical practice. Conflict of Interest: Research was a collaboration with Varian Medical Systems.

TH‐C‐350‐03: A Dosimetric Validation of RapidArc Treatment Plans for 5 Treatment Sites

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TH‐C‐350‐03: A Dosimetric Validation of RapidArc Treatment Plans for 5 Treatment Sites