Multi-isocentric 4π volumetric-modulated arc therapy approach for head and neck cancer

To explore the feasibility of multi-isocentric 4π volumetric-modulated arc therapy (MI4π-VMAT) for the complex targets of head and neck cancers.

Twenty-five previously treated patients of HNC underwent re-planning to improve the dose distributions with either coplanar VMAT technique (CP-VMAT) or noncoplanar MI4π-VMAT plans. The latter, involving 3-6 noncoplanar arcs and 2-3 isocenters were re-optimized using the same priorities and objectives. Dosimetric comparison on standard metrics from dose-volume histograms was performed to appraise relative merits of the two techniques. Pretreatment quality assurance was performed with IMRT phantoms to assess deliverability and accuracy of the MI4π-VMAT plans. The gamma agreement index (GAI) analysis with criteria of 3 mm distance to agreement (DTA) and 3% dose difference (DD) was applied.

CP-VMAT and MI4π-VMAT plans achieved the same degree of coverage for all target volumes related to near-to-minimum and near-to-maximum doses. MI4π-VΜΑΤ plans resulted in an improved sparing of organs at risk. The average mean dose reduction to the parotids, larynx, oral cavity, and pharyngeal muscles were 3 Gy, 4 Gy, 5 Gy, and 4.3 Gy, respectively. The average maximum dose reduction to the brain stem, spinal cord, and oral cavity was 6.0 Gy, 3.8 Gy, and 2.4 Gy. Pretreatment QA results showed that plans can be reliably delivered with mean gamma agreement index of 97.0 ± 1.1%.

MI4π-VMAT plans allowed to decrease the dose-volume-metrics for relevant OAR and results are reliable from a dosimetric standpoint. Early clinical experience has begun and future studies will report treatment outcome.