Dosimetric effect of collimator rotation on intensity modulated radiotherapy and volumetric modulated arc therapy for rectal cancer radiotherapy

Article type: Research Article

Authors: Abdulameer, Mohammed S.^a | Pallathadka, Harikumar^{b; *} | Menon, Soumya V.^c | Rab, Safia Obaidur^d | Hjazi, Ahmed^{e; 1} | Kaur, Mandeep^f | Sivaprasad, G.V.^g | Husseen, Beneen^{h; i; j} | Al-Mualm, Mahmood^k | Banaei, Amin^{l; *}

Affiliations: [a] Medical Laboratory Techniques Department, AL-Maarif University College, Anbar, Iraq | [b] Manipur International University, Imphal, Manipur, India | [c] Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), Bangalore, Karnataka, India | [d] Department of Clinical Laboratory Sciences, College of Applied Medical Science, King Khalid University, Abha, Saudi Arabia | [e] Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia | [f] Department of Sciences, Vivekananda Global University, Jaipur, Rajasthan, India | [g] Department of Basic Science & Humanities, Raghu Engineering College, Visakhapatnam, India | [h] Medical Laboratory Technique College, the Islamic University, Najaf, Iraq | [i] Medical Laboratory Technique College, the Islamic University of Al Diwaniyah, Al Diwaniyah, Iraq | [j] Medical Laboratory Technique College, the Islamic University of Babylon, Babylon, Iraq | [k] Department of Medical Laboratories Technology, Al-Nisour University College, Nisour Seq. Karkh, Baghdad, Iraq | [l] Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

Correspondence: [*] Corresponding authors: Harikumar Pallathadka, Manipur International University, Imphal, Manipur, India, E-mail: [email protected]; ORCID: https://orcid.org/0000-0002-0705-9035 and Amin Banaei, Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Al-Ahmad and Chamran Cross, Tehran 1411713116, Iran. Tel.: +98 21 43822449; Fax: +982144338293, E-mail: [email protected].

Note: [1] Orcid: 0000-0002-1129-6930.

Abstract: INTRODUCTION:Intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) are the main radiotherapy techniques for treating and managing rectal cancer. Collimator rotation is one of the crucial parameters in radiotherapy planning, and its alteration can cause dosimetric variations. This study assessed the effect of collimator rotation on the dosimetric results of various IMRT and VMAT plans for rectal cancer. MATERIALS AND METHODS:Computed tomography (CT) images of 20 male patients with rectal cancer were utilized for IMRT and VMAT treatment planning with various collimator angles. Nine different IMRT techniques (5, 7, and 9 coplanar fields with collimator angles of 0°, 45°, and 90°) and six different VMAT techniques (1 and 2 full coplanar arcs with collimator angles of 0°, 45°, and 90°) were planned for each patient. The dosimetric results of various treatment techniques for target tissue (conformity index [CI] and homogeneity index [HI]) and organs at risk (OARs) sparing (parameters obtained from OARs dose–volume histograms [DVH]) as well as radiobiological findings were analyzed and compared. RESULTS:The 7-fields IMRT technique demonstrated lower bladder doses (V40Gy, V45Gy), unaffected by collimator rotation. The 9-fields IMRT and 2-arcs VMAT (excluding the 90-degree collimator) had the lowest V35Gy and V45Gy. A 90-degree collimator rotation in 2-arcs VMAT significantly increased small bowel and bladder V45Gy, femoral head doses, and HI values. Radiobiologically, the 90-degree rotation had adverse effects on small bowel NTCP (normal tissue complication probability). No superiority was found for a 45-degree collimator rotation over 0 or 30 degrees in VMAT techniques. CONCLUSION:Collimator rotation had minimal impact on dosimetric parameters in IMRT planning but is significant in VMAT techniques. A 90-degree rotation in VMAT, particularly in a 2-full arc technique, adversely affects PTV homogeneity index, bladder dose, and small bowel NTCP. Other evaluated collimator angles did not significantly affect VMAT dosimetrical or radiobiological outcomes.

Keywords: Rectal cancer, intensity modulated radiotherapy, volumetric modulated arc therapy, collimator, radiobiologic parameters, dosimetric parameters

DOI: 10.3233/XST-240172

Journal: Journal of X-Ray Science and Technology, vol. 32, no. 5, pp. 1331-1348, 2024