Radiotherapy for unresectable sinonasal cancers: Dosimetric comparison of intensity modulated radiation therapy with coplanar and non-coplanar volumetric modulated arc therapy |
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| Affiliation: | 1. Unit of Radiotherapy 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;2. Unit of Medical Physics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;3. Unit of Medical Physics, A.O. San Gerardo, Milan, Italy;4. Unit of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;1. Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan;2. Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan;3. Department of Otolaryngology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan;1. Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA;2. Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA;3. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA;4. Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA;5. Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, 07103, USA;1. Department of Otolaryngology – Head and Neck Surgery, Wayne State University School of Medicine, 4201 Saint Antoine, 5E-UHC, Detroit, MI 4201, USA;2. Rhinology Section, North Shore University Hospital, Manhasset, NY, USA;3. Department of Otolaryngology, New York University School of Medicine, New York, NY, USA;4. Weill Cornell University College of Medicine, New York, NY, USA;5. Department of Otolaryngology – Head and Neck Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA;6. Endoscopic Skull Base Surgery Program, Department of Otolaryngology – Head and Neck Surgery, Rhinology and Sinus Surgery, Otolaryngology Research, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA;7. Department of Neurological Surgery, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA;8. Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA;1. Department of Oncology, Aarhus University Hospital, Denmark;2. Danish Center for Particle Therapy, Aarhus University Hospital, Denmark;3. Department of Ophthalmology, Aarhus University Hospital, Denmark;4. Department of Oncology, Odense University Hospital, Denmark;5. Department of Ophthalmology, Odense University Hospital, Denmark;6. Unit for Psychooncology and Health Psychology, Department of Psychology, Aarhus University, Denmark;7. Center of Functionally Integrative Neuroscience, Aarhus University, Denmark;8. Department of Endocrinology, Aarhus University Hospital, Denmark |
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| Abstract: | Background and purposeTo compare volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) plans for treatment of unresectable paranasal sinuses cancers (PNSCs) with different clinical presentations.Material and methodsFour patients treated for primary target volume only (group 1), four requiring elective nodal irradiation (group 2) and four with positive nodes in macroscopic disease (group 3) were selected. For each patient were generated 7 fields IMRT, coplanar VMAT (c-VMAT) and non-coplanar VMAT (nc-VMAT) treatment plans. Total doses were 70 Gy and 54 Gy to high dose planning target volume (HD-PTV) and low-dose-PTV, respectively. Dose–volume histogram, conformity and homogeneity index (CI and HI), and monitor units (MUs) per Gy were evaluated.ResultsVMAT provided significantly better target coverage, in terms of V100% (Volume encompassed by the isodose 100%), than IMRT, in particular when nc-VMAT was used. In general, organ at risk sparing is similar with the three approaches, although nc-VMAT can allow a statistically significant reduction of dose to contralateral parotid gland and cochlea for all three groups.ConclusionsVMAT can offer significant improvement of treatment for all unresectable PNSCs over existing IMRT techniques. In particular, nc-VMAT may be a further advantage for those patients with sinonasal cancers and involvement of the nodes in whom large volumes and complex/irregular shape have to be irradiated, even if clinical benefits should be established in the future. |
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| Keywords: | Intensity modulated radiation therapy Volumetric modulated arc therapy Unresectable paranasal sinus cancer Target coverage Normal tissue sparing Dosimetric comparison |
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