Volumetric-modulated arc radiotherapy for skull-base and non-skull-base head and neck cancer: a treatment planning comparison with fixed Beam IMRT.

The purpose of this study is to compare the dose distribution, monitor units (MUs) and radiation delivery time between volumetric-modulated arc (VMAT) and fix-beam intensity modulated radiotherapy (FB-IMRT) in skull-base and non-skull-base head and neck cancer (HNC). CT datasets of 8 skull-base and 7 non-skull-base HNC were identified. IMRT and VMAT plans were generated. The prescription dose ranged 45-70 Gy (1.8-2.2 Gy/fraction). The VMAT delivery time was measured when these plans were delivered to the patients. The FB-IMRT delivery time was generated on a phantom. Comparison of dose-volume histogram data, MUs, and delivery times was performed using T-test. Our results show that both plans yield similar target volume coverage, homogeneity, and conformity. In skull-base cases, compared to FB-IMRT, VMAT generated significantly smaller hot-spot inside PTV (2.0% vs. 4.5%, p = 0.031), lower maximum chiasm dose (32 ± 11 Gy vs. 41 ± 15 Gy, p = 0.026), lower ipsilateral temporal-mandibular joint dose (D33: 41.4 Gy vs. 46.1 Gy, p = 0.016), lower mean ipsilateral middle ear dose (43 ± 9 Gy vs. 38 ± 10 Gy, p = 0.020) and a trend for lower optic nerve, temporal lobe, parotid, and oral cavity dose. In non-skull-base cases, doses to normal tissues were similar between the two plans. There was a reduction of 70% in MUs (486 ± 95 vs. 1614 ± 493, p < 0.001) and 73% in delivery times (3.0 ± 0.6 vs. 11.0 ± 3.3 min, p < 0.001) favoring VMAT. We conclude that VMAT appears to spare more normal tissues from high radiation dose for the tested skull-base tumors. Dosimetrically, both approaches were equivalent for non-skull-base tumor with VMAT using fewer MUs and shorter delivery time.