Comparison of plan quality and robustness using VMAT and IMRT for breast cancer

IF 1.8 4区物理与天体物理 Q2 PHYSICS, MULTIDISCIPLINARY

Open Physics Pub Date : 2024-05-15 DOI:10.1515/phys-2024-0026

Chuou Yin, Juan Deng, Guojian Mei, Hao Cheng, Yingying He, Jiang Liu

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引用次数: 0

Abstract

To evaluate the plan quality and robustness of volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) for breast cancer, 50 patients, including 25 patients who received radiotherapy after breast-conserving surgery (BCR) and 25 patients who received postmastectomy radiotherapy (PRT), were selected for this study. Nominal VMAT and IMRT plans were generated for each patient on Eclipse treatment planning system (version 15.6). The dosimetric metrics, dose distribution, gamma passing rate, and delivery time were compared. In addition, 12 uncertainty plans with plan isocenter uncertainty and CT density uncertainty were recalculated based on the nominal plans for each patient. The dose volume histogram (DVH) band width (DVHBW) was adopted to quantify the plan robustness of the nominal plans for the perturbed scenarios in this study. For BCR, the dosimetric metrics except planning target volume (PTV) conformal index (CI) and ipsilateral lung V 5 were not statistically different for IMRT and VMAT plans. PTV CI of VMAT plans was better than that of IMRT plans (VMAT: 0.923 ± 0.024, IMRT: 0.855 ± 0.032, p = 0.003). The ipsilateral lung V 5 of VMAT plan was higher than that of IMRT plan (VMAT: 42.4% ± 2.8%, IMRT: 40.5% ± 4.0%, p = 0.045). The VMAT plans save more than 1.20 min compared to the IMRT plans (VMAT: 0.87 min, IMRT: 2.08 min, p < 0.001). The gamma passing rates of VMAT plans were better than those of IMRT plans (3 mm/3%, VMAT: 99.7% ± 0.2%, IMRT: 99.4% ± 0.4%, p < 0.001; 2 mm/2%, VMAT: 97.2% ± 1.0%, IMRT: 96.9% ± 0.6%, p = 0.108). For PRT, the dosimetric metrics of VMAT plans, including PTV D mean, homogeneity index (HI), CI, and D max of spinal cord, were significantly better than those of IMRT plans. The VMAT plans save more than 45% time compared with IMRT plans (VMAT: 1.54 min, IMRT: 2.81 min, p < 0.001). The difference in gamma passing rates between VMAT plans and IMRT plans was not statistically significant. For the plan robustness, the DVHBW of VMAT plans and IMRT plans for BCR were 2.09% ± 0.23% and 2.98% ± 0.40%, respectively (p < 0.05). For PRT, the DVHBW of VMAT plans was significantly better than those of IMRT plans (VMAT: 3.05% ± 0.26%, IMRT: 3.57% ± 0.27%, p < 0.05). The results show that the dosimetric metrics of VMAT plans were comparable to those of IMRT plans. More importantly, the VMAT plans had excited dose distribution and fast execution efficiency. The plan robustness of VMAT plans were superior.

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使用 VMAT 和 IMRT 治疗乳腺癌的计划质量和稳健性比较

为了评估乳腺癌容积调强弧形治疗（VMAT）和调强放射治疗（IMRT）的计划质量和稳健性，本研究选取了 50 名患者，包括 25 名在保乳手术（BCR）后接受放射治疗的患者和 25 名接受乳房切除术后放射治疗（PRT）的患者。在 Eclipse 治疗计划系统（15.6 版）上为每位患者生成了名义 VMAT 和 IMRT 计划。对剂量学指标、剂量分布、伽马通过率和传输时间进行了比较。此外，还根据每位患者的名义计划重新计算了 12 个具有计划等中心不确定性和 CT 密度不确定性的不确定性计划。本研究采用剂量容积直方图（DVH）带宽（DVHBW）来量化扰动情况下名义计划的计划稳健性。对于 BCR，除规划靶体积（PTV）保形指数（CI）和同侧肺 V 5 外，IMRT 和 VMAT 计划的剂量学指标在统计学上没有差异。VMAT 计划的 PTV 保形指数优于 IMRT 计划（VMAT：0.923 ± 0.024，IMRT：0.855 ± 0.032，P = 0.003）。VMAT计划的同侧肺V 5高于IMRT计划（VMAT：42.4% ± 2.8%，IMRT：40.5% ± 4.0%，p = 0.045）。与 IMRT 计划相比，VMAT 计划节省了 1.20 分钟以上（VMAT：0.87 分钟，IMRT：2.08 分钟，p < 0.001）。VMAT 计划的伽马通过率优于 IMRT 计划（3 毫米/3%，VMAT：99.7% ± 0.2%，IMRT：99.4% ± 0.4%，p <；0.001；2 毫米/2%，VMAT：97.2% ± 1.0%，IMRT：96.9% ± 0.6%，p = 0.108）。对于 PRT，VMAT 计划的剂量学指标，包括 PTV D 平均值、均匀性指数（HI）、CI 和脊髓的 D 最大值，均明显优于 IMRT 计划。VMAT 计划比 IMRT 计划节省 45% 以上的时间（VMAT：1.54 分钟，IMRT：2.81 分钟，p < 0.001）。VMAT 计划与 IMRT 计划在伽马通过率上的差异没有统计学意义。在计划稳健性方面，VMAT计划和IMRT计划对BCR的DVHBW分别为2.09%±0.23%和2.98%±0.40%（p <0.05）。对于 PRT，VMAT 计划的 DVHBW 明显优于 IMRT 计划（VMAT：3.05% ± 0.26%，IMRT：3.57% ± 0.27%，p < 0.05）。结果表明，VMAT 计划的剂量测定指标与 IMRT 计划相当。更重要的是，VMAT 计划具有良好的剂量分布和快速的执行效率。VMAT 计划的计划稳健性更优。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Open Physics PHYSICS, MULTIDISCIPLINARY-

CiteScore

3.20

自引率

5.30%

发文量

审稿时长

18 weeks

期刊介绍： Open Physics is a peer-reviewed, open access, electronic journal devoted to the publication of fundamental research results in all fields of physics. The journal provides the readers with free, instant, and permanent access to all content worldwide; and the authors with extensive promotion of published articles, long-time preservation, language-correction services, no space constraints and immediate publication. Our standard policy requires each paper to be reviewed by at least two Referees and the peer-review process is single-blind.