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Purpose: The quality of intensity-modulated radiotherapy (IMRT) highly depends on the choice of beam orientations and optimization algorithms used in the treatment planning. The present work reports dosimetric study of IMRT plans generated using preselected equiangular beam orientations (PSBO) and beam angle optimization (BAO) for the patients of prostate, head and neck, and esophagus carcinoma.Materials and Methods: The computed tomography (CT) datasets of 30 patients treated with IMRT for prostate, head and neck, and esophagus carcinoma were selected. Two IMRT plans were made for each patient. First plan was prepared for seven to nine fields PSBO in coplanar arrangement. The second plan was made using the BAO by a computerized algorithm compatible treatment planning system (TPS). The dose-volume histograms (DVHs) of PSBO and BAO plans were compared for all the patients. The treatment plans were compared using the parameters delivered monitor units (MUs), doses delivered to organs at risk (OARs), target coverage (conformity index (CI)), homogeneity index (HI), and quality index (QI).Results: DVHs generated showed that OARs receive almost identical or slightly better doses in case of BAO as compared to PSBO. CI, HI, and QI values were almost same for two plans. However, we have noticed significant reduction in MUs for all the plans generated using BAO.Conclusions: It is concluded that BAO provides superior plan with respect to MUs and should be used whenever possible in IMRT planning. [ABSTRACT FROM AUTHOR]

Context: The increasing popularity of intensity-modulated radiotherapy (IMRT) stems from its ability to generate a more conformal plan than hitherto possible with conventional planning. As a result, IMRT is in widespread use across diverse indications. However, the inherent nature of IMRT delivery makes it monitor unit inefficient and leads to increased normal tissue integral dose. This in turn may result in an increased risk of radiation-induced second malignancies. Aim: To calculate the risk of second malignancy post-IMRT. Settings and Design: Observational study in a tertiary care institute. Materials and Methods: Eighteen previously untreated patients with head and neck cancers (n = 10) and prostate cancer (n = 8) were selected. In these patients, selected infield organs around the planning target volume were contoured, viz. brain and thyroid in patients with head and neck cancer and bladder, rectum and small intestine in patients with carcinoma prostate. The estimates of radiation-induced malignancies in these organs and the whole of the body were derived using the concept of Organ Equivalent Dose. Statistical Analysis Used: Descriptive statistics (SPSS version 12). Results: The modal estimated incidence of radiation-induced malignancies was 129.87, 1.4, 0.10, 3.42, 7.789 and 129.85 per 10,000 person-years for the brain, thyroid, bladder, rectum, small intestine and whole body respectively. Conclusions: The estimated risk of radiation-induced malignancies in the thyroid and rectum was similar to the available literature, while the risk for bladder carcinomas was lower than that reported. However, the calculated risk of radiation-induced tumors of the brain was more than that reported with conventional radiation therapy. We propose that estimation of the risk of radiation-induced malignancies should be a part of the plan evaluation process and special care should be taken before using this modality in young patients with benign tumors in the head and neck region. [ABSTRACT FROM AUTHOR]

2D array of ionization chambers can be used for both absolute and relative dose verification of patient-specific intensity-modulated radiotherapy (IMRT) quality assurance. After an analysis of the dose linearity and spatial resolution of this 2D array (I'mRT MatriXX), the signal sampling time of 200 ms was selected for data acquisition. Multiple-sequence acquisitions at the nearest 4 positions with the shift of half of the distance between the centers of two adjacent ion chambers increase the spatial resolution up to four times when used with this I'mRT MatriXX. IMRT verification of head-and-neck case, which requires a large area for dosimetric verification, can be done with limited size of 24x24 cm², depending on the user requirements. It is found that the convolution method can also be used to improve the IMRT dose verification with the same parameters of the passing criteria significantly, viz., up to 99.87% agreement, by smoothening the treatment planning system profile. [ABSTRACT FROM AUTHOR]

Background: Intensity-modulated radiotherapy using simultaneous integrated boost (SIB-IMRT) is an attractive method for the treatment of head and neck cancers with sparing of the salivary function. Aims: To assess the feasibility, toxicity, and tumor control using SIB-IMRT in locally advanced head and neck cancers in the Indian setting. Settings and Design: The study was conducted in a regional cancer center in northern India. A review of the treatment result of the first 20 patients is presented. Methods and Materials: SIB-IMRT was planned for 20 patients—14 patients were treated with the SIB-72 schedule delivering a dose of 72 Gy, 66 Gy, and 57 Gy to the PTVGTV, PTVCTV1, and PTVCTV2 in 33 fractions. Six patients were treated with the SIB-66 schedule delivering 66 Gy, 60 Gy, and 54 Gy to the above-mentioned volumes in 30 fractions. Patients were monitored for toxicity using the CTCAE v 3.0 criteria. Descriptive analysis of toxicity and actuarial estimates of the loco-regional control and survival are presented. Results: Grade III mucositis was seen in 65% patients. None of the patients had Grade III dermatitis. The projected 2-year overall survival was 95%. Conclusion: SIB-IMRT schedules evaluated were found to be safe and effective and are being subjected to further prospective studies. [ABSTRACT FROM AUTHOR]