Treatment of lung cancer using volumetric modulated arc therapy and image guidance: A case study
Abstract
Background. Volumetric modulated arc therapy (VMAT) is a radiotherapy technique in which the gantry rotates while the beam is on. Gantry speed, multileaf collimator (MLC) leaf position and dose rate vary continuously during the irradiation. For optimum results, this type of treatment should be subject to image guidance. The application of VMAT and image guidance to the treatment of a lung cancer patient is described. Material and methods. In-house software AutoBeam was developed to facilitate treatment planning for VMAT beams. The algorithm consisted of a fluence optimisation using the iterative least-squares technique, a segmentation and then a direct-aperture optimisation. A dose of 50 Gy in 25 fractions was planned, using a single arc with 35 control points at 10° intervals. The resulting plan was transferred to a commercial treatment planning system for final calculation. The plan was verified using a 0.6cm3 ionisation chamber and film in a rectangular phantom. The patient was treated supine on a customised lung board and imaged daily with cone-beam CT for the first three days then weekly thereafter. Results. The VMAT plan provided slightly improved coverage of the planning target volume (PTV) and slightly lower volume of lung irradiated to 20 Gy (V20) than a three-field conformal plan (PTV minimum dose 85.0 Gy vs. 81.8 Gy and lung V20 31.5% vs. 34.8%). The difference between the measured and planned dose was −1.1% (measured dose lower) and 97.6% of the film passed a…
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