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Impact of flattening filter-free beams on remaining volume at risk in lung cancer treatment

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Abstract

Modern radiotherapy machines offer a new modality, like flattening filter-free beam (FFF), which is used especially in stereotactic body radiation therapy (SBRT) to reduce treatment time. The remaining volume at risk (RVR) is known as undefined normal tissue, and assists in evaluating late effects such as carcinogenesis. This study aimed to compare the effects of flattening and un-flattened beams on RVR in lung cancer treated by conventional doses using volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT). Twenty-three lung cancer patients with a prescribed dose of 60 Gy delivered in 30 fractions were selected retrospectively. Four treatment plans were generated for each case (VMAT FF, VMAT FFF, IMRT FF and IMRT FFF). Mean doses to RVR and volumes that received low doses (V15Gy, V10Gy and V5Gy) were introduced as RVR evaluation parameters. Variance percentage comparison between flattening filter (FF) and FFF for the RVR evaluation parameters gave 2.38, 1.10, 1.80 and 2.22 for VMAT, and 1.73, 1.18, 1.62 and 1.81 for IMRT. In contrast, VMAT and IMRT RVR evaluation parameters resulted in variance percentage differences of 10.29, 5.02, − 8.84 and − 4.82 for FF, and 11.18, 4.96, − 8.59 and − 4.48for FFF. It is concluded that in terms of RVR evaluation parameters, FFF is clinically beneficial compared to FF for RVR, due to the decrease in mean RVR dose and low-dose irradiated RVR volume. Furthermore, VMAT is preferred in the mean RVR dose and V15Gy, while IMRT is better in V10Gy and V5Gy for RVR.

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Data availability

All data generated or analyzed during this study are included in this published article (the raw data will be available in case required them from the authors).

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Authors and Affiliations

  1. Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman

    Mahmoud Mohamed Alfishawy

  2. Radiation Physics, Faculty of Science, Al -Azhar University, Cairo, Egypt

    Amr Ismail Kany

  3. Radiation Oncology Department, Faculty of Medicine, Al -Azhar University, Cairo, Egypt

    Khaled Mohamed Elshahat

Authors
  1. Mahmoud Mohamed Alfishawy
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  2. Amr Ismail Kany
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  3. Khaled Mohamed Elshahat
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Mahmoud Alfishawy Conceptualization-Methodology-Data Collection-Writing - Original Draft Khaled Elshahat Conceptualization-Writing - Review & Editing Amr Kany Writing - Review & Editing

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Correspondence to Mahmoud Mohamed Alfishawy.

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Alfishawy, M.M., Kany, A.I. & Elshahat, K.M. Impact of flattening filter-free beams on remaining volume at risk in lung cancer treatment. Radiat Environ Biophys (2024). https://doi.org/10.1007/s00411-024-01073-4

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