Helen Nguyen

DOS 773 – Clinical Practicum III

Fall 2019

Esophagus Plan Comparison

At my clinical site, esophagus plans are treated differently according to the dosimetrist and

depending on the patient. Some use full arcs and some use partial arcs and avoidance sectors.

The esophagus patient I pulled up had been previously treated with two full arcs, so I decided to

replicate that plan for this paper. Figure 1 shows the beam arrangements for the esophagus plan I

did with the methods used in my clinic. Figure 2 shows the beam arrangements according to

Matt Palmer’s “SupaFireFly” technique. I used 6x energy for both plans and kept similar

objectives when optimizing.

Figure 1. Beam arrangement for esophagus plan used in clinic.

Figure 2. Beam arrangement for “SupaFireFly” Technique.

The prescription is 5,040 cGy total which is to deliver 180 cGy in 28 fractions. After

running the plans and normalizing each plan to 95% of PTV receiving 100% of the prescription,
I evaluated the isodose lines. The VMAT plan was more conformal to the PTV but spread more

low dose to lung and heart, as seen in Figure 3a-3c. It also had slightly less 105% in the PTV,

however had a higher hotspot of 5,450 cGy versus the SupaFireFly’s hotspot of 5,389 cGy.

The SupaFireFly technique delivered a mean dose of 1,483 cGy to the heart, which is

lower than the 1,540 cGy mean dose from the VMAT plan, as seen in Figure 4a and 4b. The

SupaFireFly technique also delivered a lower mean dose to the right lung at a mean of 911 cGy

versus 1,201 cGy with the VMAT plan. However, the SupaFireFly delivered a higher mean dose

to the left lung at a mean dose of 1,237 cGy versus 1,161 cGy using VMAT. Additionally, the

SupaFireFly technique delivered a higher point dose to the spinal cord at 3,391 cGy versus 2,943

cGy with the VMAT plan.

The VMAT and SupaFireFly plans are both acceptable plans in terms of coverage, global

dose maximum, and constraints being met. The SupaFireFly technique offers advantages such as

lower heart and right lung dose, however has drawbacks such as higher left lung and spinal cord

dose. Therefore, there are other factors such as physician preference, previous treatment, and

patient’s overall health status to consider before saying which technique is superior.

Figure 3a. Axial view of isodose lines for VMAT (left) vs SupaFireFly (right).
Figure 3b. Sagittal view of isodose lines for VMAT (left) vs SupaFireFly (right).

Figure 3c. Frontal view of isodose lines for VMAT (left) vs SupaFireFly (right).
Figure 4a. DVH comparison between VMAT (squares) and SupaFireFly (triangles) plans.

Figure 4b. DVH values for VMAT (squares) and SupaFireFly (triangles) plans.