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Impact of split X-jaw technique on target volume coverage and organ at risk sparing in prostate cancer: a comparative dosimetric study

Published online by Cambridge University Press:  13 May 2022

Gautam Sarma Open the ORCID record for Gautam Sarma [Opens in a new window] ,
Jyotiman Nath Open the ORCID record for Jyotiman Nath [Opens in a new window] ,
Shachindra Goswami Open the ORCID record for Shachindra Goswami [Opens in a new window] ,
Pranjal Goswami Open the ORCID record for Pranjal Goswami [Opens in a new window] ,
Shashi Bhushan Sharma Open the ORCID record for Shashi Bhushan Sharma [Opens in a new window]  and
Apurba Kumar Kalita Open the ORCID record for Apurba Kumar Kalita [Opens in a new window]
Gautam Sarma
Affiliation:
Department of Radiation Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
Jyotiman Nath
Affiliation:
Department of Radiation Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
Shachindra Goswami
Affiliation:
Department of Radiation Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
Pranjal Goswami
Affiliation:
Department of Radiation Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
Shashi Bhushan Sharma*
Affiliation:
Department of Radiation Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
Apurba Kumar Kalita
Affiliation:
Department of Radiation Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
*
Author for Correspondence: Shashi Bhushan Sharma, Dr Bhubaneswar Borooah Cancer Institute, Gopinath Nagar, Guwahati, Assam 781016, India. E-mail: s.sharma3322@gmail.com
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Abstract

Introduction:

The Varian Trilogy linear accelerator’s multi-leaf collimator moves on a carriage with a maximum leaf span of 15 cm. The traditional open and limited X-jaw technique of volumetric-modulated arc radiotherapy (VMAT) yields a relatively compromised dose distribution within the planning target volume (PTV) region. This study aimed to determine whether the split X-jaw planning technique for VMAT improves plan quality regarding target dose coverage and organs at risk (OAR) sparing for PTVs that require a field size of more than 15 cm in the X-jaw direction in prostate cancer patients.

Method:

Computed tomography data sets from 15 patients with prostate cancer were enrolled in the study. Only the PTVs requiring a field size larger than 18 cm in the X-jaw position were considered, and a dose of 4500 cGy in 25 fractions was prescribed. For each case, three separate treatment plans were generated: open, limited and split X-jaw planning techniques with similar planning objectives

Results:

The split X-jaw technique resulted in statistically significant superior coverage of PTV when compared with the open (P < 0·0001) and limited methods (P < 0·001). The split technique delivered a lower dose to the OARs, although statistical significance could not be achieved. D2% (cGy) was lowest for the PTV in the split technique (4684·8 ± 18·16) and highest for the open technique (4710 ± 18·75), P < 0·001.

Conclusion:

The x-split jaw technique can replace the traditional open X-jaw practice of VMAT for PTVs requiring an X-jaw width of more than 15 cm in the Varian linear accelerator.

Keywords

multi-leaf collimatorprostate radiotherapysplit X-jawvarianVMAT
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e41
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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