EVALUATION OF VMAT vs IMRT RADIATION PLANNING IN

CA PROSTATE PATIENTS

ADIA

Synopsis
M. Phil (Physics)

Submitted by
Ainain Yousuf
PHP01161013
2016 – 2018

Supervisor
Dr. M Abdul Wasaye
Assistant Professor
Faculty of Physics
The University of Lahore
Lahore, Pakistan
Contents:

1. Introduction.

2. Literature Review.

3. Objectives.

4. Plan of Research work and Methodology.

5. Place of Work and Facilities Available.

6. References.
1. Introduction:
Prostate cancer is a cancer of walnut size gland found only in males. The gland
functions to secrete a liquid portion of seminal fluid, which is important for carrying
the sperm for reproduction. [1] It is a major health unease, particularly in developed
countries with a higher proportion of elder males. The type of cancer is seen in old
age males and has been rarely found before the age of 50. The first case of prostate
cancer was described in 1853 by J. Adams, a medical surgeon by profession at The
[2]
London Hospital by histological examination of affected tissues. About 1.1
million men have been annually diagnosed with prostate cancer and more than
[3]
300,000 die every year. The existence of prostate cancer depends on different
[4]
factors such as age, race and family history. During the last decade, the overall
percentage has progressively increased from 73.4% in 1999-2001 to 83.4% in 2005-
[5] [6]
2007. These statistics show that prostate cancer is a widely variable disease.
Population genetic studies on prostate cancer show that three factors such as age,
race and family history may contribute to the development of prostate cancer. [7] [8]
As far as treatment planning is concerned different plannings have been adopted to
treat prostate cancer but my current study is carried out to investigate and gain
insight into the application of VMAT plans and IMRT for treatment of prostate
cancers.
2. Literature Review:

Explored literature shows that prostate cancer prevails higher in western populations
[6]
as compared to Asian populations. Different techniques have emerged for
detection and therapeutic purpose in different types of cancers particularly in
prostate cancer. Most exciting and accurate techniques used for detection of prostate
cancers include intensity modulated radiotherapy (IMRT) and volumetric-
[9]
modulated arc therapy (VMAT). Precise radiation doses to the specific target
within the malignant tumors can be accomplished by application of compute
controlled linear accelerators in IMRT. The radiation doses allowed by IMRT give
3D shape of tumors by controlled and modulated intensity of radiation beams. IMRT
has been applied for the reduction of toxicity in controlled doses. Its complex
treatment requires longer treatments on daily basis, additional safety and planning is
documented before patients are treated. This technique has been extensively used to
treat different cancers like head, nervous system, and neck and prostrate. It is
oblivious from the studies that IMRT has limited application in treating soft tissues
from breast, lung, and thyroid, gastrointestinal and gynaecological malignancies. [9]
The volumetric modulated arc therapy (VMAT) is another advanced technique
which has been employed to administer the radiation doses to prostate cancer. This
technique achieves highly accurate conformal dose distributions with improved
coverage in comparison to conventional tissue therapies in particular when
compared with the advantages of IMRT. VMAT is more efficient in time lapse
[10]
delivery of radiation doses as compared to IMRT. The VMAT introduced first
time in 2007 has evolved an emerging technique for treatment of prostate cancers.
VMAT technique is applied to treat whole target volume by using one or two arcs,
even though complex cases may require arcs. This technique is actually a modified
[11]
form of single arc IMAT technique with variable range of radiation dose. The
comparative account of both the techniques revealed the efficacy and limitations of
their application in treating prostate cancers. The virtual analysis of VMAT and
IMRT has showed that VMAT has emerged as good technique for efficient delivery
[11]
and plan quality. In a study VMAT has proved more efficient than IMRT in
treatment of ten prostate cancers upon comparing different parameters like resultant
target, organ-at-risk, dose-volume histograms (DVHs). The rectal doses were
reduced for all the 10 patients when VMAT was employed. So this study
authenticates superiority over the use of VMAT over IMRT for treatment to prostate
[12]
cancers. In comparison, IMRT plans are generated in faster rate than VMAT.
Due to uncertainty of achieving the planning guidelines and longer time duration to
[13]
generate VMAT plans, IMRT has been used in certain prostate cancers.
Radiobiological measures have come up with the conclusion that the IMRT plans
had the lowest risks for normal tissue complications and if we talk about the risk for
secondary malignancies, the IMRT plans have showed the lowest values for both
bladder and rectum. [14]
3. Objectives:

The objectives of my research are:

1) Comparative investigation and surveys of VMAT and IMRT radiation planning

techniques from the case studies of prostate cancer patients.

2) Statistical comparison of these two planning techniques based on the survey

conducted to authenticate advantage of one technique over another.

4. Plan of Research work and Methodology:

For VMAT we will use Varian software, offering comprehensive treatment planning
systems that help to simplify modern radiation therapy planning for all kinds of
treatment. The treatment planning we opt for is Eclipse that allows the planning
process without sacrificing the plan quality. It is designed for more speed, control
and advanced care. A photon dose calculation model, the Analytical Anisotropic
Algorithm (AAA), is implemented in Eclipse Integrated Treatment Planning. It has
fast efficient planning workflow and standardization using clinical protocols and
Smart Segmentation like features that enable faster and more streamlined proton
therapy planning. Easy 4D viewing enables planning for organ motion for gated or
non-gated treatments. Field Specific target allows for compensating for the effect of
setup error, internal target motion, and range uncertainty around the clinical target
volume For IMRT we will use pencil beam scanning to precisely target a tumor.
4. Place of Work and Facilities Available:

I am doing my practical work from the Radiation Oncology Department, Shaukat

Khanum Memorial Cancer Hospital and Research Centre, Lahore. The Radiology
department has X-ray, fluoroscopy, ultrasound, mammography, CT scanner, MRI
facilities, and the PET-CT scanner.
6. References:
[1] SiegelR, MaJ, ZouZ, JemalA. Cancerstatistics, 2014. CACancerJ Clin 2014;
64:9–29. doi:10.3322/caac.21208

[2] Adams, J. (1853). The case of scirrhous of the prostate gland with corresponding
affliction of the lymphatic glands in the lumbar region and in the pelvis. Lancet, 1(1),
393-393.

[3] Greenlee, R. T., Hill‐Harmon, M. B., Murray, T., & Thun, M. (2001). Cancer
statistics, 2001. CA: a cancer journal for clinicians, 51(1), 15-36. 2001

[4] Arnold, M., Karim-Kos, H. E., Coebergh, J. W., Byrnes, G., Antilla, A., Ferlay,
J., & Soerjomataram, I. (2015). Recent trends in incidence of five common cancers
in 26 European countries since 1988: Analysis of the European Cancer Observatory.
European journal of cancer, 51(9), 1164-1187.

[5] De Angelis, R., Sant, M., Coleman, M. P., Francisci, S., Baili, P., Pierannunzio,
D., & Bielska-Lasota, M. (2014). Cancer survival in Europe 1999–2007 by country
and age: results of EUROCARE-5—a population-based study. The lancet oncology,
15(1), 23-34.

[6] Ross, R. K. &Schottenfeld, D. in Cancer Epidemiology and Prevention 2nd edn

(edsSchottenfeld, D., Searle,J.G. &Fraumeni, J. F.) 1180–1206 (Oxford Univ.
Press,New York, 1997).

[7] Jansson, K. F., Akre, O., Garmo, H., Bill-Axelson, A., Adolfsson, J., Stattin, P.,
& Bratt, O. (2012). Concordance of tumor differentiation among brothers with
prostate cancer. European urology, 62(4), 656-661.
[8] Hemminki, K. Familial risk and familial survival in prostate cancer. World J
Urol, 2012. 30: 143

[9] Quan, E. M., Li, X., Li, Y., Wang, X., Kudchadker, R. J., Johnson, J. L., & Zhang,
X. (2012). A comprehensive comparison of IMRT and VMAT plan quality for
prostate cancer treatment. International Journal of Radiation Oncology* Biology*
Physics, 83(4), 1169-1178.

[10] Hardcastle, N., Tomé, W. A., Foo, K., Miller, A., Carolan, M., & Metcalfe, P.
(2011). Comparison of prostate IMRT and VMAT biologically optimised treatment
plans. Medical Dosimetry, 36(3), 292-298.

[11] Teoh, M., Clark, C. H., Wood, K., Whitaker, S., &Nisbet, A. (2011).
Volumetric modulated arc therapy: a review of current literature and clinical use in
practice. The British journal of radiology, 84(1007), 967-996.

[12]Wolff, D., Stieler, F., Abo-Madyan, Y., Polednik, M., Steil, V., Mai, S., &Lohr,
F. (2008). Volumetric Intensity Modulated Arc Therapy (VMAT) vs. Serial
Tomotherapy and Segmental (Step and Shoot) IMRT for Treatment of Prostate
Cancer. International Journal of Radiation Oncology• Biology• Physics, 72(1),
S562.

[13] Martin, J. M., Handorf, E. A., Price, R. A., Cherian, G., Buyyounouski, M. K.,
Chen, D. Y., ... & Horwitz, E. M. (2015). Comparison of testicular dose delivered
by intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc
therapy (VMAT) in patients with prostate cancer. Medical Dosimetry, 40(3), 186-
189.
[14] Mavroidis, P., Komisopoulos, G., Buckey, C., Mavroeidi, M., Swanson, G. P.,
Baltas, D., & Stathakis, S. (2017). Radiobiological evaluation of prostate cancer
IMRT and conformal-RT plans using different treatment protocols. Physica
Medica: European Journal of Medical Physics, 40, 33-41.