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Feasibility and Robustness of Using Overlapping VMAT Arcs for Conformal Irradiation of Large Irregular PTVs

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H Liu

H Liu*, J Kim , Z Chen , Yale New Haven Hospital, New Haven, CT


SU-E-T-181 Sunday 3:00PM - 6:00PM Room: Exhibit Hall

Purpose:To investigate the feasibility and robustness of using multiple overlapping arcs for delivering volumetric modulated arc therapy (VMAT) to irregular PTVs with large superior-inferior (SI) dimensions.

Methods:A patient with stage IV alveolar rhabdomyosarcoma, with a combined PTV length of 56 cm in SI direction, was planned and treated in our department using two VMAT arcs overlapped along the SI direction to take advantage of the much needed dose sculpting capabilities of VMAT. The overlapping VMATs, each consisted of two arcs, were optimized simultaneously using Varian Eclipse system. The susceptibility of the resulting plan to uncertainties associated the set up of two separate isocenters during treatment was investigated by comparing the dose distributions resulted from small shifts introduced into the isocenter position. The robustness of this technique was further assessed for plans generated using different amount of overlap between the overlapping arcs.

Results:When the plan was generated with 6 cm overlap between adjacent arcs, maximum dose variations observed near overlapping edges was up to 9.2%, 10%, and 26.7% for setup uncertainties of 2 mm, 3 mm, and 5 mm, respectively. By increasing the junction overlap to 16 cm, maximum dose variations was reduced to 4.2%, 6.5%, and 10.2% for setup uncertainties of 2 mm, 3 mm, and 5 mm, respectively. In general, dose variation was found to increase dramatically with increasing magnitude of setup uncertainty. The technique can be made more robust against setup uncertainty by using large overlap between adjacent VMAT arcs.

Conclusion:Overlapping VMAT arcs can be used effectively for conformal irradiation of PTVs with large SI dimension. The dosimetric impact of uncertainties in required isocenter shifts can be minimized by planning with large overlap between adjacent arcs and by keeping setup uncertainty ≤ 2mm.

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