Abstract
Preoperative radiotherapy or combined chemoradiotherapy for locally advanced rectal
cancer (LARC) can cause acute and late gastrointestinal (GI) side-effects. There is
thought to be a dose-volume relationship between small bowel irradiation and the development
of these effects. A planning study was undertaken to compare small bowel sparing for
a range of 3D conformal and dynamic arc planning solutions. A planning study was carried
out for 20 LARC patients. Organs at risk (OAR) contoured included bowel loops and
peritoneal space (PS). For each of the 20 patients, 5 plans were created: (1) standard
3D conformal plan; (2) standard dual dynamic arc plan; (3) dual dynamic arc plan with
90° avoidance sector through the anterior portion of the patient; (4) dual dynamic
arc plan with an anterior avoidance structure in the optimizer; (5) dual dynamic arc
plan with both an anterior avoidance structure and an avoidance sector. The prescription
was 50.4 Gy in 28 fractions to the planning target volume (PTV). Five Dose Volume
Levels (DVLs; V15 Gy, V20 Gy, V25 Gy, V35 Gy, V40 Gy, and V50.4 Gy) for bowel and PS were selected. The DVLs were compared between the plans using Friedman
Tests and Wilcoxon Signed Rank Tests. Comparison of the 5 plans revealed that a dual
dynamic arc plan containing both an anterior avoidance sector and structure significantly
improved the dose to the bowel compared to a standard 3D conformal plan and to a standard
dual dynamic arc plan. This improvement was achieved while maintaining PTV coverage.
This novel dual dynamic arc planning technique that uses both an avoidance sector
and structure reduces the dose to the bowel and PS, which may lead to a reduction
in GI toxicity.
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Article info
Publication history
Published online: October 22, 2018
Accepted:
September 25,
2018
Received in revised form:
September 22,
2018
Received:
July 4,
2018
Identification
Copyright
© 2018 Published by Elsevier Inc. on behalf of American Association of Medical Dosimetrists.
