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Dosimetric and radiobiological evaluation of four radiation techniques in preoperative rectal cancer radiotherapy

Published online by Cambridge University Press:  20 August 2020

Vasiliki Softa ,
Yiannis Kiouvrekis Open the ORCID record for Yiannis Kiouvrekis [Opens in a new window] ,
Anna Makridou ,
Constantin Kappas ,
George Kyrgias  and
Kiki Theodorou
Vasiliki Softa
Affiliation:
Department of Medical Physics, Medical School, University of Thessaly, Larissa, Greece
Yiannis Kiouvrekis*
Affiliation:
University of Nicosia, Nicosia, Cyprus Department of BioMedical Sciences, University of West Attica, Athens, Greece
Anna Makridou
Affiliation:
Department of Medical Physics, Theageneio Anticancer Hospital, Thessaloniki, Greece
Constantin Kappas
Affiliation:
Department of Medical Physics, Medical School, University of Thessaly, Larissa, Greece
George Kyrgias
Affiliation:
Department of Radiation Oncology, Medical School, University of Thessaly, Larissa, Greece
Kiki Theodorou
Affiliation:
Department of Medical Physics, Medical School, University of Thessaly, Larissa, Greece
*
Address for correspondence: Kiouvrekis Yiannis, Department of BioMedical Sciences, University of West Attica, Athens, Greece. E-mails: yiannis.kiouvrekis@gmail.com, kiouvrekis.y@uniwa.gr, kiouvrekis.y@uth.gr
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Abstract

Purpose:

To compare tumour dose distribution, conformality, homogeneity, normal tissue avoidance, tumour control probability (TCP) and normal tissue complication probability (NTCP) using 3D conformal radiation therapy (3DCRT), 3- and 4-field intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in patients with locally advanced rectal cancer.

Materials and methods:

Twenty-four patients staged T1–3N+M0 with locally advanced rectal cancer underwent neoadjuvant chemoradiation therapy. Four different radiotherapy plans were prepared for each patient: 3DCRT, 3- and 4-field IMRT and VMAT are evaluated for target distribution using CI and homogeneity index (HI), normal tissue avoidance using Dmax, V45, V40, V50 and TCP and NTCP using the Lyman–Kutcher–Burman model.

Results:

VMAT has better HI (HI = 1·32) and 3DCRT exhibited better conformality (CI = 1·05) than the other radiotherapy techniques. With regard to normal tissue avoidance, all radiotherapy plans met the constraints. Dmax in the 3DCRT plans was statistically significant (p = 0·04) for bladder and no significant differences in V40 and V50. In the bowel bag, no significant differences in Dmax for any radiotherapy plan and V40 was lower in 3DCRT than VMAT (p = 0·024). In the case of femoral heads, 3DCRT has a statistically significant lower dose on Dmax than 4-field IMRT (p = 0·00 « 0·05). VMAT has the biggest TCP (80·76%) than the other three radiotherapy plans. With regard to normal tissue complications, probabilities were shown to be very low, of the order of 10-14 and 10-41 for bowel bag and femoral heads respectively.

Conclusions:

It can be concluded that 3DCRT plan improves conformity and decreases radiation sparing in the organ at risks, but the VMAT plan exhibits better homogeneity and greater TCP.

Keywords

dosimetric parametersnormal tissue complication probabilitypreoperative radiation therapyrectal cancertumour control probability
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 20 , Issue 4 , December 2021 , pp. 398 - 405
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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