Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 32727
Verifying the Supremacy of Volume Modulated Arc Therapy Over Intensity Modulated Radiation Therapy: Pelvis Malignancies’ Perspective

Authors: M. Umar Farooq, T. Ahmad Afridi, M. Zia-Ul-Islam Arsalan, U. Hussain Haider, S. Ullah


Cancer, a leading fatal disease worldwide, can be treated with various techniques including radiation therapy. It involves the use of ionizing radiation to target cancer cells. On basis of source placement, radiation therapy is of two types i.e., Brachytherapy and External Beam Radiotherapy (EBRT). EBRT has evolved from 2-D conventional therapy to 3-D Conformal radiotherapy (3D-CRT) and then Intensity-Modulated Radiotherapy (IMRT). IMRT improves dose conformity and sparing of organs at risk. Volumetric Modulated Arc Therapy (VMAT) is a modern technique that uses treatment delivery in arcs with rotation of the gantry. In this report, a dosimetry comparison was performed between IMRT and VMAT. This study was conducted in the Radiotherapy Department of the Institute of Nuclear Medicine and Oncology Lahore (INMOL). Ten patients with Prostate Carcinoma were selected for this study to compare the methods. Simulation of these patients was done with help of a CT Simulator. All target volumes and organs were delineated by the oncologists. Then suitable fields/arcs were applied which cover volumes effectively. This was followed by the optimization of plans for both techniques for every patient. Finally, a comparison of evaluating parameters e.g., Conformity Index (CI), Volume Coverage, Homogeneity Index (HI), Organ Doses, and MUs (Monitor Units) was performed. We obtained better results of target conformity indices from VMAT (CI = 1.16) than IMRT (CI = 1.24). VMAT was better in organ sparing too. Also, VMAT shows fewer MUs (733 MUs) as compared to IMRT (2149 MUs). From this study, it is concluded that VMAT is a better treatment technique than IMRT. This technique will enhance treatment efficiency as it takes less time in obtaining the required results. Also, a very less scatter dose will be delivered to the patient.

Keywords: 2-D Conventional Radiotherapy, 3-D Conformal Radiotherapy, Intensity Modulated Radiotherapy, Prostate Carcinoma, Radiotherapy, Volumetric Modulated Arc Therapy.

Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 272


[1] “International Agency for Research on Cancer,” 2018.
[2] D. LIN, S. LIN, and Y. LIAW, “Non‐surgical treatment of hepatocellular carcinoma,” J. Gastroenterol. Hepatol., vol. 12, no. 9‐10, pp. S319–S328, 1997.
[3] F. M. Khan, The physics of radiation therapy. Lippincott Williams & Wilkins, 2010.
[4] P. M. L. Teo, B. B. Y. Ma, and A. T. C. Chan, “Radiotherapy for nasopharyngeal carcinoma—transition from two-dimensional to three-dimensional methods,” Radiother. Oncol., vol. 73, no. 2, pp. 163–172, 2004.
[5] A. R. Farajollahi, F. Bouzarjomehri, and M. Kiani, “Comparison between clinically used irregular fields shielded by Cerrobend and standard lead blocks,” J. Biomed. Phys. Eng., vol. 5, no. 2, p. 77, 2015.
[6] A. J. Mundt and J. C. Roeske, Intensity modulated radiation therapy: a clinical perspective. PMPH-USA, 2005.
[7] M. Mazonakis, J. Damilakis, H. Varveris, and N. Gourtsouiannis, “Radiation dose to testes and risk of infertility from radiotherapy for rectal cancer,” Oncol. Rep., vol. 15, no. 3, pp. 729–733, 2006.
[8] T. Bortfeld, “IMRT: a review and preview,” Phys. Med. Biol., vol. 51, no. 13, p. R363, 2006.
[9] C. X. Yu, “Intensity-modulated arc therapy with dynamic multileaf collimation: an alternative to tomotherapy,” Phys. Med. Biol., vol. 40, no. 9, p. 1435, 1995.
[10] M. Khalajipirbalouti, “Rapid Re-optimization of Prostate Intensity-Modulated Radiation Therapy Using Regularized Linear Programming.” 2013.
[11] P. Alaei, P. D. Higgins, R. Weaver, and N. Nguyen, “Comparison of dynamic and step-and-shoot intensity-modulated radiation therapy planning and delivery,” Med. Dosim., vol. 29, no. 1, pp. 1–6, 2004.
[12] J. L. Bedford, “Treatment planning for volumetric modulated arc therapy,” Med. Phys., vol. 36, no. 11, pp. 5128–5138, 2009.
[13] T. R. Mackie et al., “Tomotherapy: a new concept for the delivery of dynamic conformal radiotherapy,” Med. Phys., vol. 20, no. 6, pp. 1709–1719, 1993.
[14] K. Otto, “Volumetric modulated arc therapy: IMRT in a single gantry arc,” Med. Phys., vol. 35, no. 1, pp. 310–317, 2008.
[15] P.-H. Mackeprang et al., “Assessing dose rate distributions in VMAT plans,” Phys. Med. Biol., vol. 61, no. 8, p. 3208, 2016.
[16] F. M. Khan, P. W. Sperduto, and J. P. Gibbons, Khan’s Treatment Planning in Radiation Oncology:Lippincott Williams & Wilkins, 2021.
[17] C. Elith, S. E. Dempsey, N. Findlay, and H. M. Warren-Forward, “An introduction to the intensity-modulated radiation therapy (IMRT) techniques, tomotherapy, and VMAT,” J. Med. Imaging Radiat. Sci., vol. 42, no. 1, pp. 37–43, 2011.
[18] L. Wilke et al., “ICRU report 91 on prescribing, recording, and reporting of stereotactic treatments with small photon beams,” Strahlentherapie und Onkol., vol. 195, no. 3, pp. 193–198, 2019.
[19] M. H. Finlay, I. Ackerman, R. G. Tirona, P. Hamilton, L. Barbera, and G. Thomas, “Use of CT simulation for treatment of cervical cancer to assess the adequacy of lymph node coverage of conventional pelvic fields based on bony landmarks,” Int. J. Radiat. Oncol. Biol. Phys., vol. 64, no. 1, pp. 205–209, 2006.
[20] J.-C. Rosenwald, O. Dahl, and G. Gaboriot, “Classification of conformal radiotherapy.”
[21] R. A. Brooks and G. Di Chiro, “Theory of image reconstruction in computed tomography,” Radiology, vol. 117, no. 3, pp. 561–572, 1975.
[22] T. Lee et al., “Comparative analysis of SmartArc‐based dual arc volumetric‐modulated arc radiotherapy (VMAT) versus intensity‐modulated radiotherapy (IMRT) for nasopharyngeal carcinoma,” J. Appl. Clin. Med. Phys., vol. 12, no. 4, pp. 158–174, 2011.
[23] Q. Wu, R. Mohan, M. Morris, A. Lauve, and R. Schmidt-Ullrich, “Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas. I: dosimetric results,” Int. J. Radiat. Oncol. Biol. Phys., vol. 56, no. 2, pp. 573–585, 2003.