A Dosimetric Comparison of Volumetric Modulated Arc Therapy (VMAT) and High Dose Rate (HDR) Brachytherapy in Localized Cervical Cancer Radiotherapy

Background: Cervical cancer radiotherapy is usually administrated through 3-Dimensional Conformal Radiation Therapy (3DCRT) followed by a brachytherapy (BT) boost.

Purpose: To investigate whether Volumetric Modulated Arc Therapy (VMAT) can replace High Dose Rate (HDR) intracavitary BT boost for patients undergoing cervical cancer radiotherapy.

Materials And Methods: Computed Tomography (CT) images for ten patients with tandem and ovoids were included in this study. Target volumes, rectum, bladder, sigmoid, small bowel and both femoral heads were delineated. Two plans were carried out including (a) a BT plan optimized manually by modifying dwell time and Ir-192 source positions, (b) a VMAT plan generated using two partial arcs with 10 MV photon beam. The prescribed dose was 7 Gy. The relevant dose volume parameters (DVPs) of target volumes and OARs for the two plans were analyzed statistically using SPSS Wilcoxon Signed Rank test.

Results: VMAT plan showed a significant reduction of 9.1%, 9.3%, 15.4%, 14.4% and 13.1% in rectum maximum dose, rectum D2cc, bladder maximum dose, bladder D2cc and sigmoid maximum dose (P < 0.05). VMAT and BT plans showed comparable D2cc of sigmoid and small bowel maximum doses (P = 0.333 and P = 0.646). On the other hand, VMAT showed significantly higher small bowel D2cc and maximum point dose for both femoral heads comparing to BT plan (P < 0.05). Also, VMAT plan yielded greater homogeneous target coverage compared to BT plan (P < 0.05).

Conclusion: The study demonstrated that VMAT plan achieves significant dose reduction of rectum, bladder and sigmoid, as well as superior homogeneous target coverage compared to BT plan. On the other hand, VMAT delivers more radiation exposures to small bowel and femoral heads.