Comparison of Volumetric Modulated Arc Therapy and Three-Dimensional Conformal Radiotherapy in Postoperative High-Grade Glioma: A Dosimetric Comparison

• Main Authors: Harikesh Singh, Ajeet Gandhi, Shantanu Sapru, Rohini Khurana, Rahat Hadi, Sambit Nanda, Satyajeet Rath, Avinav Bharati, Anoop Srivastava, Surendera Mishra, Kamal Sahni, Nuzhat Husain, Madhup Rastogi
• Format: Article
• Language: English
• Published: Mashhad University of Medical Sciences 2019-09-01
• Series: Iranian Journal of Medical Physics
• Subjects: Glioma; Computer-Assisted Radiotherapy Planning; volumetric modulated arc therapy; Three-Dimensional Conformal Radiotherapy
• Online Access: http://ijmp.mums.ac.ir/article_12447_450c53c0c4e576da94f36d9e90535f03.pdf

<strong><em>Introduction:</em></strong> We aimed to dosimetrically compare three-dimensional conformal radiotherapy (3D-CRT) and volumetric modulated arc therapy (VMAT) in terms of planning target volume (PTV) coverage, organ at risk (OAR) sparing, and conformity index (CI). <strong><em>Material and Methods:</em></strong> Planning data of 26 high grade glioma (HGG) patients were used. Prescribed dose for 3D-CRT was 46Gy in 23 fractions to low-risk PTV (LR-PTV) and 14 Gy in 7 fractions to high-risk PTV (HR-PTV). VMAT plans were conducted using 46 Gy in 30 fractions to LR-PTV and 60 Gy in 30 fractions to HR-PTV. <strong><em>Results:</em></strong> Tumor locations were frontal, parietal, temporal, and multi-lobed in 27%, 15%, 23%, and 35% of cases, respectively. Histology was glioblastoma multiform in 89% of patients. Mean values of PTV D95 (dose received by 95% volume) in 3D-CRT and VMAT were 96.6% and 98.8% for the LR-PTV and 97.3% and 99% for HR-PTV (P<0.001), respectively. Mean values of CI in 3D-CRT were 0.96 and 0.97 for LR-PTV and HR-PTV and 0.98 and 0.99 for LR-PTV and HR-PTV of VMAT (both P<0.001), respectively. Mean Dmax of right optic nerve (maximum point dose received by the organ) for 3D-CRT and VMAT were 31.59 and 25.57Gy (P=0.02). Mean Dmax for left optic nerve and optic chiasm were 28.81 and 22.14 Gy (P=0.019) and 42.24 and 37.12 Gy (P=0.055) respectively for 3D-CRT versus VMAT. Doses to other OARs were not statistically different between 3D-CRT and VMAT. <strong><em>Conclusion: </em></strong>VMAT achieved better coverage of the PTV and delivered fewer doses to bilateral optic nerve and chiasm.