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Title: Investigation of 4D dose in volumetric modulated arc therapy-based stereotactic body radiation therapy: does fractional dose or number of arcs matter?
Authors: Shintani, Takashi
Nakamura, Mitsuhiro
Matsuo, Yukinori  kyouindb  KAKEN_id  orcid (unconfirmed)
Miyabe, Yuki  kyouindb  KAKEN_id
Mukumoto, Nobutaka  kyouindb  KAKEN_id
Mitsuyoshi, Takamasa
Iizuka, Yusuke  kyouindb  KAKEN_id  orcid (unconfirmed)
Mizowaki, Takashi  kyouindb  KAKEN_id  orcid (unconfirmed)
Author's alias: 新谷, 尭
中村, 光宏
松尾, 幸憲
宮部, 結城
椋本, 宜学
光吉, 隆真
飯塚, 裕介
溝脇, 尚志
Keywords: Health, Toxicology and Mutagenesis
Radiology Nuclear Medicine and imaging
Issue Date: Mar-2020
Publisher: Oxford University Press (OUP)
Journal title: Journal of Radiation Research
Volume: 61
Issue: 2
Start page: 325
End page: 334
Abstract: The aim of this study was to assess the impact of fractional dose and the number of arcs on interplay effects when volumetric modulated arc therapy (VMAT) is used to treat lung tumors with large respiratory motions. A three (fractional dose of 4, 7.5 or 12.5 Gy) by two (number of arcs, one or two) VMAT plan was created for 10 lung cancer cases. The median 3D tumor motion was 17.9 mm (range: 8.2–27.2 mm). Ten phase-specific subplans were generated by calculating the dose on each respiratory phase computed tomography (CT) scan using temporally assigned VMAT arcs. We performed temporal assignment of VMAT arcs using respiratory information obtained from infrared markers placed on the abdomens of the patients during CT simulations. Each phase-specific dose distribution was deformed onto exhale phase CT scans using contour-based deformable image registration, and a 4D plan was created by dose accumulation. The gross tumor volume dose of each 4D plan (4D GTV dose) was compared with the internal target volume dose of the original plan (3D ITV dose). The near-minimum 4D GTV dose (D99%) was higher than the near-minimum 3D internal target volume (ITV) dose, whereas the near-maximum 4D GTV dose (D1%) was lower than the near-maximum 3D ITV dose. However, the difference was negligible, and thus the 4D GTV dose corresponded well with the 3D ITV dose, regardless of the fractional dose and number of arcs. Therefore, interplay effects were negligible in VMAT-based stereotactic body radiation therapy for lung tumors with large respiratory motions.
Rights: © The Author(s) 2020. Published by Oxford University Press on behalf of The Japanese Radiation Research Society and Japanese Society for Radiation Oncology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
DOI(Published Version): 10.1093/jrr/rrz103
PubMed ID: 32030408
Appears in Collections:Journal Articles

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