Dosimetric comparison between IMRT and VMAT in irradiation for peripheral and central lung cancer

The aim of the present study was to compare intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) in irradiation of lung cancer. Plans of 14 patients were compared. The results demonstrated that in peripheral lung cancer, V5 (%) of the lung in partial-arc (PA)-VMAT was decreased compared with IMRT, single-arc (SA)-, and double partial-arc (2PA)-VMAT. V30 (%) of the lung in IMRT was decreased compared with SA-, PA- and 2PA-VMAT. In the case of planning target volume (PTV) not encompassing the mediastinum in central lung cancer, the conformality index (CI) and heterogeneity index (HI) of SA-VMAT was improved compared with IMRT, PA-, and 2PA-VMAT. The received dose of heart in SA-VMAT was higher compared with IMRT, PA- and 2PA-VMAT. V30 (%) and V5 (%) of the lung in IMRT was higher compared with SA-, PA- and 2PA-VMAT; V10 (%) of the lung in 2PA was decreased compared with IMRT, SA- and PA. In the case of PTV encompassing the mediastinum in central lung cancer, the HI and CI of 2PA was improved compared with IMRT, SA- and PA-VMAT. The received dose of heart in 2PA was higher compared with IMRT, SA- and PA-VMAT. V30 (%) and V5 (%) of the lung in 2PA-VMAT was higher compared with IMRT, SA- and PA-VMAT. V20 (%) of the lung in 2PA was decreased compared with IMRT, SA- and PA-VMAT. In conclusion, it may be necessary to classify the radiotherapy plans of lung cancer into three categories including peripheral lung cancer, PTV not encompassing the mediastinum of central lung cancer, and PTV encompassing the mediastinum of central lung cancer. Each of IMRT, SA-VMAT, PA-VMAT, 2PA-VMAT strategy had individual advantages, and therefore it may be crucial to employ different planning techniques for different disease classifications and OAR requirements.