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Dosimetric comparison of anterior posterior-posterior anterior 2-field three-dimensional conformal radiotherapy, 4-field three-dimensional conformal radiotherapy and "forward" plan intensity modulated radiotherapy techniques in female lymphoma patients irradiated to neck and mediastinum

1 Department of Radiation Oncology, Dr. Lütfi Kırdar Kartal Training and Research State Hospital, Kartal, Turkey
2 Department of Radiation Oncology, Dokuz Eylül University Medical Faculty, Izmir, Turkey
3 Department of Radiation Oncology, Erzurum Regional Training and Research State Hospital, Yakutiye, Erzurum, Turkey
4 Department of Radiation Oncology, Marmara University Medical Faculty, Göztepe, Istanbul, Turkey
5 Department of Physics, Dokuz Eylül University Science Faculty, Tınaztepe, Izmir, Turkey

Correspondence Address:
Cenk Umay,
Department of Radiation Oncology, Dokuz Eylül University Medical Faculty, İnciraltı 35340, Izmir
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1482.193108

Aim: Dosimetric comparison of three different techniques in female lymphoma patients who had radiotherapy (RT) to the neck and mediastinum. Setting and Design: Retrospective clinical study. Materials and Methods: Computerized tomography-simulator images of eight patients were obtained retrospectively. Using 6 MV-X photon energy, RT plans were formed with three different techniques (anterior posterior-posterior anterior 2-field three-dimensional conformal RT [AP-PA 2-field 3D-CRT], 4-field 3D-CRT and "forward" plan intensity modulated RT [FPIMRT]). Comparisons were in terms of homogeneity index (HI), conformity index (CI), and inhomogeneity coefficient for planning target volume (PTV); mean lung dose, V 5Gy , V 10Gy , V 20Gy , V 30Gy for lung; D mean , V 7.5Gy , V 15Gy , V 25Gy for heart; D mean , V 3.5Gy , V 10Gy , V 20Gy for breast; D max for spine; D mean , V 10Gy , V 18Gy , V 25Gy , V 30Gy for thyroid. Statistical Analysis Used: Since nonparametric tests had to be used due to the study population being < 30, Friedman and Wilcoxon signed-rank tests were implemented in trilateral and bilateral comparison of techniques, respectively. For statistical significance, P value was required to be <0.05. Results: When FPIMRT was compared with AP-PA and 4-field techniques with respect to, HI (AP-PA/FPIMRT P: 0.017; 4-field/FPIMRT P: 0.03) and CI (AP-PA/FPIMRT P: 0.018; 4-field/FPIMRT P: 0.042), FPIMRT was more advantageous. In addition, FPIMRT was found more useful in terms of D max (AP-PA/FPIMRT P: 0.012; 4-Field/FPIMRT P: 0.012) for spinal cord and D mean (AP-PA/FPIMRT P: 0.012; 4-field/FPIMRT P: 0.012) for thyroid. Conclusion: FPIMRT was superior in terms of PTV homogeneity and conformity. However, it was observed that for normal tissues, FPIMRT was advantageous only for spinal cord and thyroid; but it was not the most advantageous technique for some of the dose-volume parameters of the breast, lung, and heart.

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