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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Radiation Oncology
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1431082

Treating early-stage centrally-located non-small cell lung cancer with DCAT-SBRT in centers lacking the VMAT technique: a comprehensive study

Provisionally accepted
Yangyang Huang Yangyang Huang 1,2Tingting Qin Tingting Qin 2Menglin Yang Menglin Yang 2Yibao Liu Yibao Liu 1*
  • 1 East China University of Technology, Nanchang, China
  • 2 Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China

The final, formatted version of the article will be published soon.

    Background: Volumetric-modulated arc therapy (VMAT) may have the highest overall performance for stereotactic body radiotherapy (SBRT) treatment of inoperable early-stage NSCLC. However, in centers lacking the VMAT technique, the dynamic conformal arc therapy (DCAT) technique is potentially the best option for small and rounded NSCLC-SBRT. Therefore, we will comprehensively analyze the advantages of the DCAT versus the other techniques except VMAT in terms of dosimetry, plan complexity, delivery time, γ-passing rates and the interplay effect. Methods: 36 patients with early-stage centrally located NSCLC with PTV volumes < 65 cc were enrolled. All patients were redesigned with 50Gy/5f, and 100% of the prescribed dose was normalized to cover 95% of the PTV. The other two delivery techniques compared to the DCAT technique include 3-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT), which use the same parameters for all three techniques. Results: The dosimetric parameters of the 3-group plans all met the RTOG 0813 protocol. Unsurprisingly, plan complexity parameters such as segments and MUs were significantly reduced in the DCAT plans by 159.56 and 925.90 compared to the IMRT plans, respectively (all P < 0.001). The delivery time of the DCAT plans was the least of 164.51 s (all P < 0.05). Compared to the IMRT plans, the γ-passing rates were higher in the DCAT plans (P < 0.001), with the most significant difference of 6.01% in the (2%, 1 mm) criteria. As for the interplay effect, the mean dose difference (MDD) in the DCAT plans was as good as the 3DCRT plans at different respiratory amplitudes but better than the IMRT plans (all P < 0.05), and the MDD of DCAT plans did not exceed 3% in all respiratory amplitude.In centers lacking the VMAT technique, implementing SBRT treatment based on the DCAT technique for inoperable early-stage centrally-located NSCLC patients with PTV volumes < 65 cc achieves better treatment efficiency and delivery accuracy while maintaining the plan quality.

    Keywords: DCAT, SBRT, inoperable early-stage centrally-located NSCLC, Dosimetric parameter, Plan complexity, Delivery time, γ-passing rate, interplay effect

    Received: 11 May 2024; Accepted: 18 Nov 2024.

    Copyright: © 2024 Huang, Qin, Yang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Yibao Liu, East China University of Technology, Nanchang, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.