A comparative study of identical VMAT about two adjacent targets with and without fixed-jaw technique

Abstract

Background

The radiation transmission through the multileaf collimators is undesired in modern techniques such as volumetric modulated arc therapy (VMAT). According to identical plans, in this study, we aim to investigate the dosimetric impact of jaw tracking on the VMAT plans on two adjacent targets.

Methods

Two treatment plans were designed for eight pelvic (cervical) patients with two targets using the same optimization parameters. The original plan (O-plan) used automatically selected jaw positions. In the new plan (F-plan), the jaws were fixed to block two targets in two beams. The dosimetric parameters of the two plans were compared to evaluate the improvement of dose sparing for the body volume between two targets (named interOAR) in F-VMAT.

Results

The mean dose of interOAR reduced significantly from 654.96 ± 113.38 cGy for O-VMAT, to 490.84 ± 80.26 cGy for F-VMAT (p = 0.018). The monitor units (MUs) in the F-plans were 1.49-fold higher than that in the O-plan. The F and O-plan performed similarly in target dose homogeneity. The differences in Dmax of spinal cord, Dmax of spinal cord planning organ at risk volume, and V20, V30, and V40 of the intestine were insignificant.

Conclusions

VMAT plans with the fixed-jaw method can reduce the volume between two targets effectively. However, despite the plan quality, the method can only be used when the regular methods cannot reach the clinical requirements for critical organs because of additional MUs.