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Title: Evaluation of the dosimetric impact of applying flattening filter-free beams in intensity-modulated radiotherapy for early-stage upper thoracic carcinoma of oesophagus
Authors: Zhang, WZ
Lin, ZX
Yang, ZN
Fang, WS
Lai, PB
Lu, JY
Wu, VWC 
Keywords: Flattening filter-free radiation beam
Oesophagus cancer
Radiation dosimetry
Static beam intensity -modulated radiotherapy
Issue Date: 2015
Publisher: John Wiley & Sons
Source: Journal of medical radiation sciences, 2015, v. 62, no. 2, p. 108-113 How to cite?
Journal: Journal of medical radiation sciences 
Abstract: Introduction: Flattening filter-free (FFF) radiation beams have recently become clinically available on modern linear accelerators in radiation therapy. This study aimed to evaluate the dosimetric impact of using FFF beams in intensity-modulated radiotherapy (IMRT) for early-stage upper thoracic oesophageal cancer.
Methods: Eleven patients with primary stage upper thoracic oesophageal cancer were recruited. For each patient, two IMRT plans were computed using conventional beams (Con-P) and FFF beams (FFF-P), respectively. Both plans employed a five-beam arrangement and were prescribed with 64 Gy to (planning target volume) PTV1 and 54 Gy to PTV2 in 32 fractions using 6 MV photons. The dose parameters of the target volumes and organs at risks (OARs), and treatment parameters including the monitor units (MU) and treatment time (TT) for Con-P and FFF-P were recorded and compared.
Results: The mean D-5 of PTV1 and PTV2 were higher in FFF-P than Con-P by 0.4 Gy and 0.3 Gy, respectively. For the OARs, all the dose parameters did not show significant difference between the two plans except the mean V-5 and V-10 of the lung in which the FFF-P was lower (46.7% vs. 47.3% and 39.1% vs. 39.6%, respectively). FFF-P required 54% more MU but 18.4% less irradiation time when compared to Con-P.
Conclusion: The target volume and OARs dose distributions between the two plans were comparable. However, FFF-P was more effective in sparing the lung from low dose and reduced the mean TT compared with Con-P. Long-term clinical studies are suggested to evaluate the radiobiological effects of FFF beams.
ISSN: 2051-3895
EISSN: 2051-3909
DOI: 10.1002/jmrs.93
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