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We investigated the possible treatment and dosimetric advantage of volumetric modulated arc therapy (VMAT) over step-and-shoot intensity-modulated radiation therapy (step-and-hhoot IMRT) and helical tomotherapy (HT). Twelve prostate cancer patients undergoing VMAT to the prostate were included. Three treatment plans (VMAT, step-and-shoot IMRT, HT) were generated for each patient. The doses to clinical target volume and 95% of planning target volume were both >/=78 Gy. Target coverage, conformity index, dose to rectum/bladder, monitor units (MU), treatment time, equivalent uniform dose (EUD), normal tissue complication probability (NTCP) of targets, and rectum/bladder were compared between techniques. HT provided superior conformity and significantly less rectal volume exposed to 65 Gy and 40 Gy, as well as EUD/NTCP of rectum than step-and-shoot IMRT, whereas VMAT had a slight dosimetric advantage over step-and-shoot IMRT. Notably, significantly lower MUs were needed for VMAT (309.7 +/- 35.4) and step-and-shoot IMRT (336.1 +/- 16.8) than for HT (3368 +/- 638.7) (p < 0.001). The treatment time (minutes) was significantly shorter for VMAT (2.6 +/- 0.5) than step-and-shoot IMRT (3.8 +/- 0.3) and HT (3.8 +/- 0.6) (p < 0.001). Dose verification of VMAT using point dose and film dosimetry met the accepted criteria. VMAT and step-and-shoot IMRT have comparable dosimetry, but treatment efficiency is significantly higher for VMAT than for step-and-shoot IMRT and HT.
Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
This article was published in the following journal.
Name: Medical dosimetry : official journal of the American Association of Medical Dosimetrists
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