ABSTRACT
Due to large doses per fraction, stereotactic ablative radiotherapy of lung or spine
can lead to skin tissue toxicity, the amount of which depends on a variety of factors
such as target location, beam geometry, and immobilization. The effect of arc length
on spreading out entrance and exit doses and the corresponding predictions of skin
reactions has not yet been studied for stereotactic body radiotherapy volumetric modulated
arc therapy (VMAT) treatments. 58 clinically relevant VMAT stereotactic body radiotherapy
spine and lung plans were created for an anthropomorphic phantom utilizing a range
of target locations, beam geometries and arc lengths. Skin dose was assessed by considering
the National Cancer Institute skin reaction grades adjusted for 3 fraction treatments.
While the skin volumes predicted to exhibit low grade reactions decreased with arc
length, high grade reactions were found to increase at smaller arcs as well as at
full arcs where a superposition of entrance and exit doses would occur. It is possible
for skin dose to be effectively optimized by choice of arc length (within clinically
relevant boundaries) and thus minimize the skin reaction. High skin doses are often
attributed to effects arising from the distance between the planning target volume
and patient surface but this study has demonstrated that VMAT arc length is of equal
importance. Understanding this relationship will assist in minimizing skin reactions
through modification of plan parameters and will provide clinicians more information
for patient selection.
Keywords
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Article info
Publication history
Published online: December 04, 2018
Accepted:
November 6,
2018
Received in revised form:
November 1,
2018
Received:
August 22,
2018
Footnotes
No conflicts of interest.
Identification
Copyright
© 2018 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
