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• W1965370928 abstract "We aimed to define whether Volumetric arc therapy (VMAT) provides a superior dose distribution in comparison to Intensity modulated radiation therapy (Step and shoot: ssIMRT) based on target volume coverage and organ at risk (OAR) doses in adjuvant postoperative radiation therapy for pancreas adenocarcinoma patients. We have re-planned 4D CT (0-100% at 10% interval) scans of our ten consecutive patients who were treated with postoperative concurrent radiochemotherapy of 50.4 Gy (ssIMRT, 1.8 Gy/fraction/day) following Whipple surgery. Liver was delineated at MinIP phase. Treated ssIMRT plans were 6 coplanar fields (330-0-30-60-90 derece) and VMAT plans were generated as two 268-92 ° arcs. CTV was delineated as porta hepatis, superior mesenteric artery, celiac, paraaortic and postoperative bed including peripancreatic nodal area based on preoperative CT fusion. PTV was integrated tumor volume (ITV = internal CTV contoured on all respiratory data sets) plus 4 mm. The maximum dose (Gy) for spinal cord, V15,-V20- V25 for bilateral kidney, V30 and mean dose for intestine, V30-V45 for liver, total treated monitor units (MU), and mean and maximum doses for PTV were compared based on dose volume histograms. VMAT plans revealed better overall sparing for right kidney (V15- 28.3% vs 46.9%, p = 0.012; V20-16.1% vs 27.6%, p = 0.007; V25- 8.6% vs 15.2%, p = 0.005; mean dose 1549cGy vs 1987 cGy, p = 0.005) and less amount of high dose regions for left kidney (V20 11.6% vs 18.8%; p = 0.008, V25 5.7% vs 11.7%; p = 0.018), while no statistical difference was found in terms of mean doses (1155 cGy vs 1209 cGy, p = 0.33) and low dose areas (V15; 23.4% vs 29.8%, p = 0.74) for left kidney. VMAT delivered similar isodose distributions (PTV mean dose: 5164 vs 5183 cGy, PTV Max 5526 cGy vs 5505 cGy, p = 0.541) with significantly less MU (MU: 468 vs 527, p = 0.032) in comparison to ssIMRT. In terms of liver, the mean doses were found to be similar in each plan, but high dose volumes such as V30 and V45 were decreased by VMAT (VMAT vs ssIMRT: mean dose- 1507 cGy vs 1550, p = 0.168, V30- %18.3 vs % 20.1,p = 0.012, V45- %7.9 vs % 9.5,p = 0.006). VMAT was also found to be superior for intestinal doses (V30: %28.1 vs %32.9, p = 0.008, mean dose: 1963 cGy vs 2032 cGy, p = 0.05). Both plans provided acceptable and comparable spinal cord doses (cord maximum dose 3792 cGy vs 3697 cGy, p = 0.24). VMAT seems to provide more effective protection on bilateral kidneys and small intestine with better OAR doses, as well as on liver with reduced high dose volumes in this cohort. This could be speculated to investigate for more tolerable concurrent radiochemotherapy treatments by better OAR preservation." @default.
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• W1965370928 date "2012-11-01" @default.
• W1965370928 modified "2023-09-27" @default.
• W1965370928 title "Volumetric Arc Therapy Seems More Promising to Spare Organ at Risk in Adjuvant Postoperative Radiation Therapy for Pancreas Adenocarcinoma in Comparison to Step and Shoot Intensity Modulated Radiation Therapy" @default.
• W1965370928 doi "https://doi.org/10.1016/j.ijrobp.2012.07.2107" @default.
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