A dosimetric comparison of non-coplanar IMRT versus Helical Tomotherapy for nasal cavity and paranasal sinus cancer.

PURPOSES: To determine if there are clinically significant differences between the dosimetry of sinus tumors delivered by non-coplanar LINAC-based IMRT techniques and Helical Tomotherapy (HT). HT is capable of delivering highly conformal and uniform target dosimetry. However, HT lacks non-coplanar capability, which is commonly used for linear accelerator-based IMRT for nasal cavity and paranasal sinus tumors. METHODS AND MATERIALS: We selected 10 patients with representative early and advanced nasal cavity and paranasal sinus malignancies treated with a preoperative dose of 50 Gy/25 fractions without coverage of the cervical lymphatics for dosimetric comparison. Each plan was independently optimized using either Corvus inverse treatment planning system, commissioned for a Varian 2300 CD linear accelerator with 1cm multileaf collimator (MLC) leaves, or the HT inverse treatment planning system. A non-coplanar seven field technique was used in all Corvus plans with five mid-sagittal fields and two anterior oblique fields as described by Claus et al. [F. Claus, W. De Gersem, C. De Wagter, et al., An implementation strategy for IMRT of ethmoid sinus cancer and bilateral sparing of the optic pathways, Int J Radiat Oncol Biol Phys 51 (2001) 318-331], whereas only coplanar beamlets were used in HT planning. Dose plans were compared using DVHs, the minimum PTV dose to 1cm3 of the PTV, a uniformity index of planned treatment volume (PTV), and a comprehensive quality index (CQI) based on the maximum dose to optical structures, parotids and the brainstem which were deemed as the most critical adjacent structures. RESULTS: Both planning systems showed comparable PTV dose coverage, but HT had significantly higher uniformity (p<0.01) inside the PTV. The CQI for all organs at risk were equivalent except ipsilateral lenses and eyes, which received statistically lower dose from HT plans (p<0.01). CONCLUSIONS: Overall HT provided equivalent or slightly better normal structure avoidance with a more uniform PTV dose for nasal cavity and paranasal sinus cancer treatment than non-coplanar LINAC-based IMRT. The disadvantage of coplanar geometry in HT is apparently counterbalanced by the larger number of fields.