Utilizing the VMAT Technique for Treating Head and Neck Cancer with Fixed Collimator Jaws

Besim Xhafa, Ervis Telhaj, Fesal Selimi, Ylli Kaçiu, Njomza Elezaj, Blerim Rrakaqi

 
For citation: Xhafa B, Telhaj E, Selimi F, Kaçiu Y, Elezaj N, Rrakaqi B. Utilizing the VMAT Technique for Treating Head and Neck Cancer with Fixed Collimator Jaws. International Journal of Biomedicine. 2024;14(3):474-477. doi:10.21103/Article14(3)_OA14
 
Originally published September 6, 2024

Abstract: 

Radiotherapy is the preferred option for early-stage head and neck cancer (HNC), especially in cases where surgery is not feasible or for patients with other co-morbidities. Head and neck radiation therapy is still improving for better management and control of the cancer. The volumetric modulated arc therapy (VMAT) technique ensures precise and accurate treatment delivery. This study presents a clinical comparison between plans with fixed collimator jaws and free collimator jaws generated head-and-neck VMAT plans made for clinical use. The study involved 10 patients with HNC, each receiving a dose prescription of 54.00 Gy and 63.00 Gy, administered in 30 fractions with daily doses of 1.8 Gy delivered to planning target volume (PTV) and 2.1 Gy delivered to boost target volume (BTV), respectively. All patients underwent treatment using the Electa Infinity linear accelerator, with the treatment plan generated using the Monaco treatment planning system. In our study, all cases were treated using two complete arcs, with one arc following a Gantry heading CW-180.1°-180° and the opposite arc following a Gantry heading CCW-180°-180.1°. Our findings indicate that employing the VMAT technique with one side of the collimator jaws fixed and the other side free, and in the opposite order, leads to a reduction of approximately 8-10 Gy in the maximum dose to the spine for all patients, compared to the collimator method, where both collimator jaws are free.

Keywords: 
head and neck cancer • radiotherapy • collimator • spinal cord
References: 
  1. Marta GN, Silva V, de Andrade Carvalho H, de Arruda FF, Hanna SA, Gadia R, da Silva JL, Correa SF, Vita Abreu CE, Riera R. Intensity-modulated radiation therapy for head and neck cancer: systematic review and meta-analysis. Radiother Oncol. 2014 Jan;110(1):9-15. doi: 10.1016/j.radonc.2013.11.010. Epub 2013 Dec 13. PMID: 24332675.
  2. Brodin NP, Tomé WA. Revisiting the dose constraints for head and neck OARs in the current era of IMRT. Oral Oncol. 2018 Nov;86:8-18. doi: 10.1016/j.oraloncology.2018.08.018. Epub 2018 Sep 8. PMID: 30409324; PMCID: PMC6481934.
  3. Schwartz DL, Garden AS, Shah SJ, Chronowski G, Sejpal S, Rosenthal DI, Chen Y, Zhang Y, Zhang L, Wong PF, Garcia JA, Kian Ang K, Dong L. Adaptive radiotherapy for head and neck cancer--dosimetric results from a prospective clinical trial. Radiother Oncol. 2013 Jan;106(1):80-4. doi: 10.1016/j.radonc.2012.10.010. Epub 2013 Jan 29. PMID: 23369744.
  4. Hvid CA, Elstrøm UV, Jensen K, Grau C. Cone-beam computed tomography (CBCT) for adaptive image guided head and neck radiation therapy. Acta Oncol. 2018 Apr;57(4):552-556. doi: 10.1080/0284186X.2017.1398414. Epub 2017 Nov 10. PMID: 29125035.
  5. Surucu M, Shah KK, Mescioglu I, Roeske JC, Small W Jr, Choi M, Emami B. Decision Trees Predicting Tumor Shrinkage for Head and Neck Cancer: Implications for Adaptive Radiotherapy. Technol Cancer Res Treat. 2016 Feb;15(1):139-45. doi: 10.1177/1533034615572638. Epub 2015 Mar 2. PMID: 25731804.
  6. Barker JL Jr, Garden AS, Ang KK, O'Daniel JC, Wang H, Court LE, Morrison WH, Rosenthal DI, Chao KS, Tucker SL, Mohan R, Dong L. Quantification of volumetric and geometric changes occurring during fractionated radiotherapy for head-and-neck cancer using an integrated CT/linear accelerator system. Int J Radiat Oncol Biol Phys. 2004 Jul 15;59(4):960-70. doi: 10.1016/j.ijrobp.2003.12.024. PMID: 15234029.
  7. Rosenthal DI, Chambers MS, Fuller CD, Rebueno NC, Garcia J, Kies MS, Morrison WH, Ang KK, Garden AS. Beam path toxicities to non-target structures during intensity-modulated radiation therapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 2008 Nov 1;72(3):747-55. doi: 10.1016/j.ijrobp.2008.01.012. Epub 2008 May 1. PMID: 18455324; PMCID: PMC9627578.
  8. Wang ZH, Yan C, Zhang ZY, Zhang CP, Hu HS, Kirwan J, Mendenhall WM. Radiation-induced volume changes in parotid and submandibular glands in patients with head and neck cancer receiving postoperative radiotherapy: a longitudinal study. Laryngoscope. 2009 Oct;119(10):1966-74. doi: 10.1002/lary.20601. PMID: 19688858.
  9. Ward MC, Lee NY, Caudell JJ, Zajichek A, Awan MJ, Koyfman SA, Dunlap NE, Zakem SJ, Hassanzadeh C, Marcrom S, Boggs DH, Isrow D, Vargo JA, Heron DE, Siddiqui F, Bonner JA, Beitler JJ, Yao M, Trotti AM, Riaz N; Multi-Institution Re-Irradiation (MIRI) Collaborative. A competing risk nomogram to predict severe late toxicity after modern re-irradiation for squamous carcinoma of the head and neck. Oral Oncol. 2019 Mar;90:80-86. doi: 10.1016/j.oraloncology.2019.01.022. Epub 2019 Feb 8. PMID: 30846182.
  10. Sulman EP, Schwartz DL, Le TT, Ang KK, Morrison WH, Rosenthal DI, Ahamad A, Kies M, Glisson B, Weber R, Garden AS. IMRT reirradiation of head and neck cancer-disease control and morbidity outcomes. Int J Radiat Oncol Biol Phys. 2009 Feb 1;73(2):399-409. doi: 10.1016/j.ijrobp.2008.04.021. Epub 2008 Jun 14. PMID: 18556144.
  11. Takiar V, Garden AS, Ma D, Morrison WH, Edson M, Zafereo ME, Gunn GB, Fuller CD, Beadle B, Frank SJ, William WN Jr, Kies M, El-Naggar AK, Weber R, Rosenthal DI, Phan J. Reirradiation of Head and Neck Cancers With Intensity Modulated Radiation Therapy: Outcomes and Analyses. Int J Radiat Oncol Biol Phys. 2016 Jul 15;95(4):1117-31. doi: 10.1016/j.ijrobp.2016.03.015. Epub 2016 Mar 19. PMID: 27354127.
  12. Duprez F, Madani I, Bonte K, Boterberg T, Vakaet L, Derie C, De Gersem W, De Neve W. Intensity-modulated radiotherapy for recurrent and second primary head and neck cancer in previously irradiated territory. Radiother Oncol. 2009 Dec;93(3):563-9. doi: 10.1016/j.radonc.2009.10.012. Epub 2009 Nov 16. PMID: 19919885.
  13. Lee N, Chan K, Bekelman JE, Zhung J, Mechalakos J, Narayana A, Wolden S, Venkatraman ES, Pfister D, Kraus D, Shah J, Zelefsky MJ. Salvage re-irradiation for recurrent head and neck cancer. Int J Radiat Oncol Biol Phys. 2007 Jul 1;68(3):731-40. doi: 10.1016/j.ijrobp.2006.12.055. Epub 2007 Mar 26. PMID: 17379449.
  14. Cacicedo J, Navarro A, Alongi F, Gómez de Iturriaga A, Del Hoyo O, Boveda E, Casquero F, Perez JF, Bilbao P. The role of re-irradiation of secondary and recurrent head and neck carcinomas. Is it a potentially curative treatment? A practical approach. Cancer Treat Rev. 2014 Feb;40(1):178-89. doi: 10.1016/j.ctrv.2013.08.002. Epub 2013 Aug 8. PMID: 23993769.
  15. Chen AM, Phillips TL, Lee NY. Practical considerations in the re-irradiation of recurrent and second primary head-and-neck cancer: who, why, how, and how much? Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):1211-9. doi: 10.1016/j.ijrobp.2011.06.1998. PMID: 22115554.
  16. Ko EC, Forsythe K, Buckstein M, Kao J, Rosenstein BS. Radiobiological rationale and clinical implications of hypofractionated radiation therapy. Cancer Radiother. 2011 Jun;15(3):221-9. doi: 10.1016/j.canrad.2010.12.007. Epub 2011 Apr 21. PMID: 21514198.
  17. Brown E, Owen R, Harden F, Mengersen K, Oestreich K, Houghton W, Poulsen M, Harris S, Lin C, Porceddu S. Predicting the need for adaptive radiotherapy in head and neck cancer. Radiother Oncol. 2015 Jul;116(1):57-63. doi: 10.1016/j.radonc.2015.06.025. Epub 2015 Jun 30. PMID: 26142268.
  18. Ajani AA, Qureshi MM, Kovalchuk N, Orlina L, Sakai O, Truong MT. A quantitative assessment of volumetric and anatomic changes of the parotid gland during intensity-modulated radiotherapy for head and neck cancer using serial computed tomography. Med Dosim. 2013 Autumn;38(3):238-42. doi: 10.1016/j.meddos.2013.01.007. Epub 2013 Apr 1. PMID: 23558146.

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Received July 8, 2024.
Accepted August 29, 2024.
©2024 International Medical Research and Development Corporation.