Jenny Huang, Ruha Siddiqui, Andrew Edel, Amber Mehr

Comparison IMRT and VMAT V5 Lung doses

History: Predominantly in the past, 3DCRT planning was used primarily for lung cases. Lung
cancer treatment is one of the most challenging forms of treatment in radiotherapy. With the
evolution of new technology, improved planning and treatment delivery options have emerged.
A few of these new planning techniques include static IMRT and VMAT/dynamic arc therapy.

Research question: Does dynamic arc therapy produce significantly greater low dose expose as
PTV size increases compared to static IMRT.

Research Gap: Previous experiments have said V5 is not predictive of RP but didn’t examine if
V5 levels are as high as are being delivered with dynamic arcs.

Null hypothesis: Treatment type does not affect low dose to lung at any PTV size

Experimental hypothesis: Treatment type does affect low dose to lung depending on PTV size.

Interpretation of results: Failure to reject the null hypothesis might mean that current constraints
are adequate for assessing patient safety with dynamic arcs. Rejecting the null hypothesis would
mean that current constraints may not be adequate for assessing patient safety and further
research is needed to investigate clinical endpoints of treating large areas of lung with low dose.

Patient sample
· 40-50 patients from 5 sites:
● St. Paul Cancer Center
● Minneapolis VA Health Care System
● Northwestern Medicine Cancer Center
● VCU’s Massey Cancer Center
● Austin Cancer Center
· Approximately Half receiving static IMRT remaining receiving dynamic arc therapy
Patient selection
· PTV between 40-400 cc
· Centrally located tumors
· Prescribed between 55-65 Gy
Data to be examined
· PTV coverage to verify effectiveness of plan
· V20 and V30 of lung to verify quality
· Independent variables are Planning type and PTV percentage of healthy lung
· Dependent variable to be examined is V5 in lung
Planned statistic
· Analysis of covariance (Ancova)
· Categorical independent variable: treatment type
· Continuous independent covariable: normalized PTV size
· Independent variable: V5 Lung dose
Proposed Methodology:
· 40-50 Lung Cases
· TPS Systems:
● Pinnacle - CCC
● Eclipse-AAA
● Eclipse- Acuros
· Machines
● Varian IX
● Elekta
● Novalis
Work Division:
· Each group member gathers 10-12 patient plans
· Conduct analysis
· Each member assigned a section of paper to write
· Edit paper and compile data together
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