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A Comparative Dosimetric Analysis of VMAT and Multi-Beam 3D-CRT in Locally Advanced Lung Cancer Radiotherapy
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I Jalal Mustafa    , B Saifaddin Hasan , R Emad Al-Khalidi * , N Karkhi Abdulkareem , Sh Ahmed Hussein , L Jalal Ali Shah , R Najat Yousif , A Muhammad Ahmad |
| 3.Department of Pharmacology and Medical Physics and Clinical Biochemistry, College of Medicine, Hawler Medical University, Erbil, Iraq. , ruaa.hussien@hmu.edu.krd |
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Abstract: (18 Views) |
Background and Objective: Volumetric modulated arc therapy (VMAT) offers excellent dose conformity and organ‑at‑risk (OAR) sparing but requires advanced equipment, limiting its accessibility in many settings. In contrast, three‑dimensional conformal radiation therapy (3D-CRT) remains widely used, especially in resource‑limited regions. The objective of the present study was to perform a comparative dosimetric analysis of VMAT and 3D‑CRT techniques in the radiotherapy of locally advanced lung cancer, with the aim of evaluating whether a six‑beam 3D‑CRT approach could represent a viable alternative to VMAT in this clinical setting.
Methods: In this cross-sectional study, fifteen patients with stage III non-small cell lung cancer who had previously received VMAT treatment were selected and replanned using a six-field coplanar 3D-CRT technique on the Monaco planning system. Dosimetric comparisons included target coverage (minimum dose [Dmin], maximum dose [Dmax], D2%, D95%, D98%, mean dose), homogeneity index (HI), and conformity index (CI). The assessed OARs were the lungs, heart, esophagus, and spinal cord.
Findings: VMAT provided significantly better target coverage, homogeneity (p=0.001), and conformity (p=0.001) compared to 3D-CRT. Dmin to the target was significantly higher in VMAT plans (58.3±2.4 Gy) compared to 3D-CRT (54.1±3.1 Gy), indicating improved coverage of the low-dose regions within the target volume (p=0.035). Dmax was comparable between VMAT (68.9±4.5 Gy) and 3D-CRT (69.5±5.0 Gy), with no significant difference was observed. It also achieved superior sparing for heart V30 (p=0.014), esophageal V50 (p=0.016), and lung V20/V30 (p<0.05) compared to 3D-CRT. No significant differences were observed for lung V5/V10, mean heart dose, or maximum esophageal and spinal cord doses.
Conclusion: Based on the findings of the present study, while VMAT demonstrated superior dosimetric performance, optimized six-beam 3D-CRT produced clinically acceptable plans. It remains a practical alternative in settings with limited access to advanced technologies or where VMAT implementation is not feasible.
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Article number: e41 |
| Keywords: Advanced Equipment, Lung Cancer, Monaco Planning System, Radiotherapy, Target Coverage. |
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Full-Text [PDF 877 kb]
(4 Downloads)
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Type of Study: Research |
Subject:
Radiology
Received: 2025/07/2 | Accepted: 2025/08/9 | Published: 2026/09/6
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