A comparison of three different VMAT techniques for the delivery of lung stereotactic ablative radiation therapy

Fitzgerald, Rhys, Owen, Rebecca, Hargrave, Catriona, Pryor, David, Barry, Tamara, Lehman, Margot, Bernard, Anne, Mai, Tao, Seshadri, Venkatakrishnan, & Fielding, Andrew (2016) A comparison of three different VMAT techniques for the delivery of lung stereotactic ablative radiation therapy. Journal of Medical Radiation Sciences, 63(1), pp. 23-30.

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  • The purpose of this study was to investigate coplanar and non-coplanar volumetric modulated arc therapy (VMAT) delivery techniques for stereotactic ablative radiation therapy (SABR) to the lung.


  • For ten patients who had already completed a course of radiation therapy for early stage lung cancer, three new SABR treatment plans were created using (1) a coplanar full arc (FA) technique, (2) a coplanar partial arc technique (PA) and (3) a non-coplanar technique utilising three partial arcs (NCA). These plans were evaluated using planning target volume (PTV) coverage, dose to organs at risk, and high and intermediate dose constraints as incorporated by radiation therapy oncology group (RTOG) 1021.


  • When the FA and PA techniques were compared to the NCA technique, on average the PTV coverage (V54Gy) was similar (P = 0.15); FA (95.1%), PA (95.11%) and NCA (95.71%). The NCA resulted in a better conformity index (CI) of the prescription dose (0.89) when compared to the FA technique (0.88, P = 0.23) and the PA technique (0.83, P = 0.06). The NCA technique improved the intermediate dose constraints with a statistically significant difference for the D2cm and R50% when compared with the FA (P < 0.03 and <0.0001) and PA (P < 0.04 and <0.0001) techniques. The NCA technique reduced the maximum spinal cord dose by 2.72 and 4.2 Gy when compared to the PA and FA techniques respectively. Mean lung doses were 4.09, 4.31 and 3.98 Gy for the FA, PA and NCA techniques respectively.


  • The NCA VMAT technique provided the highest compliance to RTOG 1021 when compared to coplanar techniques for lung SABR. However, single FA coplanar VMAT was suitable for 70% of patients when minor deviations to both the intermediate dose and organ at risk (OAR) constraints were accepted.

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ID Code: 99969
Item Type: Journal Article
Refereed: Yes
Keywords: Dosimetry;lung cancer;stereotactic ablative radiation therapy;treatment planning;volumetric modulated arc therapy
DOI: 10.1002/jmrs.156
ISSN: 2051-3895
Divisions: Current > Schools > School of Chemistry, Physics & Mechanical Engineering
Current > QUT Faculties and Divisions > Science & Engineering Faculty
Copyright Owner: 2016 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Institute of Radiography and New Zealand Institute of Medical Radiation Technology.
Copyright Statement: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Deposited On: 13 Oct 2016 02:16
Last Modified: 14 Oct 2016 01:33

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