Comparison of Three Dimensional Conformal Radiation Therapy, Intensity Modulated Radiation Therapy and Volumetric Modulated Arc Therapy for Low Radiation Exposure of Normal Tissue in Patients with Prostate Cancer

  • Cakir, Aydin (Department of Radiation Oncology, Oncology Institute, Istanbul University) ;
  • Akgun, Zuleyha (Department of Radiation Oncology, Faculty of Medicine, Bezmialem Vakif University) ;
  • Fayda, Merdan (Department of Radiation Oncology, Oncology Institute, Istanbul University) ;
  • Agaoglu, Fulya (Department of Radiation Oncology, Oncology Institute, Istanbul University)
  • 발행 : 2015.04.29


Radiotherapy has an important role in the treatment of prostate cancer. Three-dimensional conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) techniques are all applied for this purpose. However, the risk of secondary radiation-induced bladder cancer is significantly elevated in irradiated patients compared surgery-only or watchful waiting groups. There are also reports of risk of secondary cancer with low doses to normal tissues. This study was designed to compare received volumes of low doses among 3D-CRT, IMRT and VMAT techniques for prostate patients. Ten prostate cancer patients were selected retrospectively for this planning study. Treatment plans were generated using 3D-CRT, IMRT and VMAT techniques. Conformity index (CI), homogenity index (HI), receiving 5 Gy of the volume (V5%), receiving 2 Gy of the volume (V2%), receiving 1 Gy of the volume (V1%) and monitor units (MUs) were compared. This study confirms that VMAT has slightly better CI while thev olume of low doses was higher. VMAT had lower MUs than IMRT. 3D-CRT had the lowest MU, CI and HI. If target coverage and normal tissue sparing are comparable between different treatment techniques, the risk of second malignancy should be a important factor in the selection of treatment.


  1. Ashman JB, Zelefsky MJ, Hunt MS, Leibel SA, Fuks Z (2005). Whole pelvic radiotherapy for prostate cancer using 3D conformal and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys, 63, 765-71.
  2. Bortfeld T and Webb S.(2009). Single Arc IMRT ? Phys Med Biol, 54, 9-20.
  3. Brenner DJ, Curtis RE, Hall EJ, et al (2000). Second malignancies in prostate carcinoma patients after radiotherapy compared with surgery. Cancer, 88, 398-406.<398::AID-CNCR22>3.0.CO;2-V
  4. Budäus L, Bolla M, Bossi A, et al (2012). Functional Outcomes and Complications Following Radiation Therapy for Prostate Cancer: A Critical Analysis of the Literature. Eur Urol, 61, 112-27 .
  5. Cahlon O, Zelefsky MJ, Shippy A, et al (2008). Ultra-high dose (86.4Gy) IMRT for localized prostate cancer: toxicity and biochemical outcomes. Int J Radiat Oncol Biol Phys, 71, 330-7.
  6. Cao D, Holmes TW, Afghan MK, et al (2007). Comparison of plan quality provided by intensity-modulated arc therapy and helical tomotherapy. Int J Radiat Oncol Biol Phys, 69, 240-50.
  7. Cozzi L, Dinshaw KA, Shrivastava SK, et al (2008). A treatment plan-ning study comparing volumetric arc modulation with Rapi-dArc and fixed field IMRT for cervix uteri radiotherapy. Radiother Oncol, 89, 180-91.
  8. Ding X, Dionisi F, Tang S, et al (2014). A comprehensive dosimetric study of pancreatic cancer treatment using three-dimensional conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), volumetric-modulated radiation therapy (VMAT), and passive-scattering and modulatedscanning proton therapy (PT). Med Dosim, 39, 139-45.
  9. Followill DS, Stovall MS, Kry SF, Ibbott GS (2003). Neutron source strength measurements for Varian, Siemens, Elekta and General Electric linear aacelerators. J Appl Clin Med Phys, 4, 189-94.
  10. Hall EJ, Wuu C (2003). Radiation-induced second cancers: The impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys, 56, 83-88.
  11. Hall EJ (2006). Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Ooncol Biol Phys, 65, 1-7.
  12. Kendal, WS, Nicholas, G (2007) A populationbased analysis of second primary cancers after irradiation for rectal cancer. Am J Clin Oncol, 30, 333-9.
  13. Kry SF, Salehpour M, Followill DS, et al (2005). The calculated risk of fatal secondary malignancies from intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys, 62, 1195-1203.
  14. Kutcher GJ, Burman C (1989). Calculation of complication probability factors for non-uniform normal tissue radiation:The effective volume method. Int J Radiat Oncol Biol Phys, 16, 1623-30.
  15. Luxton G, Hancock SL, Boyer AL(2004). Dosimetry and radiobiologic model comparison of IMRT and 3D conformal radiotherapy in treatment of carcinoma of the prostate. Int J Radiat Oncol Biol Phys, 59, 267-84.
  16. Murray L, Henry A, Hoskin P, et al (2013). Second primary cancers after radiation for prostate cancer:a review of data from planning studies. Radiation Oncology, 8, 172 .
  17. National council on radiation protection and measurements. limitation of exposure to ionizing radiation. NCRP report 116. bethesda (md): national council on radiation protection and measurements; 1993.
  18. Nieder AM, Porter MP, Soloway MS (2008) Radiation therapy for prostate cancer increases subsequent risk of bladder and rectal cancer: a population based cohort study. J Urol, 180, 2005-2010.
  19. Otto K (2008).Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys, 35, 310-7.
  20. Ottolenghi A, Smyth V, Trott KR (2011). The risk to healthy tissues from the use of existing and emerging techniques for radiation therapy. Radiat Prot Dosim, 143, 533-35 .
  21. Palma D, Vollans E, James K, et al (2008). Volumetric modulated arc therapy for delivery of prostate radiotherapy: Comparison with intensity-modulated radiotherapy and three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys, 72, 996-1001
  22. Pasquier D, Cavillon F, Lacornerie T, et al (2013). A dosimetric comparison of tomotherapy and volumetric modulated arc therapy in the treatment of high-risk prostate cancer with pelvic nodal radiation therapy. Int J Radiat Oncol Biol Phys, 85, 549-54.
  23. Preston D, Shimizu Y, Pierce D, Suyama A, Mabuchi K (2003) Studies of mortality of atomic bomb survivors. Report 13:solid cancer and non cancer mortality, 1950-1977. Radiat Res, 160, 381-407.
  24. Rechner LA, Howell RM, Zhang R, et al (2012). Risk of radiogenic second cancers following volumetric modulated arc therapy and proton arc therapy for prostate cancer. Phys Med Biol, 57, 7117-32 .
  25. Romanenko A, Morimura K, Wanibuchi H, et al (2003). Urinary bladder lesions induced by persistent chronic low-dose ionizing radiation. Cancer Sci, 94, 328-333.
  26. Ruben JD, Davis S, Evans C, et al (2008). The effect of intensitymodulated radiotherapy on radiation-induced second malignancies. Int J Radiat Oncol Biol Phys, 70, 1530-6.
  27. Shaffer R, Morris WJ, Moiseenko V, Welsh M, et al (2009). Volumetric modulated Arc therapy and conventional intensity-modulated radiotherapy for simultaneous maximal intraprostatic boost: a planning comparison study. Clin Oncol, 21, 401-7.
  28. Shepard DM, Cao D, Afghan MK, et al (2007). An arc-sequencing algorithm for intensity modulated arc therapy. Med Phys, 34, 464-470.
  29. Sountoulides P, Koletsas N, Kikidakis D, et al (2010). Secondary malignancies following radiotherapy for prostate cancer. Ther Adv Urol, 2, 119-125 .
  30. Swamy ST, Radha CA, Kathirvel M, Arun G, Subramanian S (2014). Feasibility study of deep inspiration breath-hold based volumetric modulated arc therapy for locally advanced left sided breast cancer patients. Asian Pac J Cancer Prev, 15, 9033-8.
  31. Tsai CL, Wu JK, Chao HL, Tsai YC, et al (2011). Treatment and dosimetric advantages between VMAT, IMRT, and helical tomotherapy in prostate cancer. Medical Dosimetry, 36, 264-271.
  32. Wang B, Xu XG (2008). Measurements of non-target organ doses using mosfet dosemeters for selected IMRT and 3D CRT radiation treatment procedures. Radiat Prot Dosim, 128, 336-42 .
  33. Wolff JM, Mason M (2012). Drivers for change in the management of prostate cancer-guidelines and new treatment techniques. BJU Int, 109, 33-41.
  34. Wu VW, Kwong DL, Sham JS (2004) Target dose conformity in 3-dimensional conformal radiotherapy and intensity modulated radiotherapy. Radiother Oncol, 71, 201-6.
  35. Xu XG, Bednarz B and Paganetti H(2008). A review of dosimetry studies on external-beam radiation treatment with respect to second cancer induction. Phys Med Biol, 53, 193-241.
  36. Yu CX, Li XA, Ma L, et al (2002). Clinical implementation of intensity-modulated arc therapy. Int J Radiat Oncol Biol Phys, 53, 453-63.
  37. Zelefsky MJ, Fuks Z, Happersett L, et al (2000). Clinical experience with intensity modulated radiation therapy (IMRT) in prostate cancer. Radiother Oncol, 55, 241-9.
  38. Zelefsky MJ, Levin EJ, Hunt M, et al. (2008). Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys, 70, 1124-9.
  39. Zelefsky MJ, Pei X, Teslova T, et al (2012). Secondary cancers after intensity-modulated radiotherapy, brachytherapy and radical prostatectomy for the treatment of prostate cancer: incidence and cause-specific survival outcomes according to the initial treatment intervention. BJU Int, 110, 1696-701.

피인용 문헌

  1. Dosimetric comparison of intensity-modulated radiotherapy and volumetric-modulated arc radiotherapy in patients with prostate cancer: a meta-analysis vol.17, pp.6, 2016,
  2. Dosimetric comparison between VMAT and RC3D techniques: case of prostate treatment vol.154, pp.2100-014X, 2017,
  3. Variations in dosimetric distribution and plan complexity with collimator angles in hypofractionated volumetric arc radiotherapy for treating prostate cancer vol.19, pp.2, 2018,
  4. Influence of Dosimetric Considerations in Evaluating Second Cancer Risks in Prostate Cancer vol.07, pp.02, 2018,