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Renee Jackson

Clinical Practicum III

September 17, 2019

Esophageal Plan Comparison

Plan 1: Rapid Arc Technique

Prescription: 28 FX at 1.8Gy/day to a total of 50.4Gy. TrueBeam Linear Accelerator.

Field Energy Field Size Collimator Gantry Angle

ARC 1 6MV 11.3 x 12 30 181 CW 179
ARC 2 6MV 11.3 x 12 330 179 CCW 181

The most common technique that is used in my clinic to treat esophageal cancer is using the
Rapid Arc. This allows a conformal dose around the PTV while sparing the surrounding critical
organs.

Organs at Risk

The organs at risk include: Spinal cord, Rt Lung, Lt Lung, Heart, Total Lung and Esophagus.
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Plan Optimization

The plan was normalized so that 95% of the target is receiving 100% of the prescription dose.
The plan normalization value was 100.7.
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Global Max Dose

The Global max dose was 106.3%. It is located inside of the PTV.

DVH
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Dose Constraints

Structure Objective Result

PTV - High Risk 95% of volume ≥ Rx dose 95% = 60 Gy

Spinal Cord V45 < 100% Max dose = 39 Gy

V20 < 37% V20 = 6 %

Total Lung
(lung - CTV)
MLD < 20 Gy Mean dose = 4 Gy

V40 < 100% V40 = %

V45 = %
Heart V45 < 67%
V60 = %

V60 < 33% Max dose = 0.8 Gy

Esophagus Mean dose < 34 Gy Mean dose = 32 Gy

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Plan 2: SupaFirefly Technique

Prescription: 28 FX at 1.8Gy/day to a total of 50.4Gy. TrueBeam Linear Accelerator.

Field Energy Field Size Collimator Gantry Angle

1 6MV 11.1 X 10.8 30 60
2 6MV 8.6 X 12.1 30 80
3 6MV 9 X 12.5 30 120
4 6MV 9.6 X 12.3 30 140
5 6MV 10.6 X 11.8 30 160
6 6MV 10.9 X 11 30 180
7 6MV 11.8 X 10.3 30 200

This plan used static IMRT fields using the SupaFirefly esophageal technique.

Organs at Risk

The organs at risk include: Spinal cord, Rt Lung, Lt Lung, Heart, and Esophagus.
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Plan Optimization
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The plan was normalized so that 95% of the target is receiving 100% of the prescription dose.
The plan normalization value was 98.4.

Global Max Dose

The Global max dose was 105.6%. It is located inside of the PTV.

DVH
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Dose Constraints

Structure Objective Result

PTV – High Risk 95% of volume ≥ Rx dose 95% = 50.4Gy

Spinal Cord V45 < 100% Max dose = 33.5Gy

V20 < 37% V20 = 3.8 %

Total Lung
(lung - CTV)
MLD < 20 Gy Mean dose = .308 Gy

V40 < 100% V40 = %

V45 = %
Heart V45 < 67%
V60 = %

V60 < 33% Max dose = 0.7Gy

Esophagus Mean dose < 34 Gy Mean dose = 25.7 Gy

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Plan Comparison

The triangles in the DVH represent the SupaFirefly plan and the squares represent the Rapid arc
plan. Both plans had very similar readings, the largest difference was the dose to the spinal cord
and heart. I would choose the Rapid Arc plan over the SupaFirefly plan. The Rapid arc plan
allowed the dose to the heart and spine to be lower, which are the two most important organs at
risk for this patient. The arrangement of the beams with the SupaFirefly technique was not as
helpful as the Rapid arc plan, because the technique placed beams going directly through spinal
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cord and heart leaving a star streaking effect of the 50% isodose line. The 50% line was more
conformal in the Rapid arc plan. However, I look forward to trying the SupaFirefly technique on
future patients.
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References

1. Palmer, Matt. IMRT “SupaFirefly” Esophagus Technique.

2. Quantec Normal Tissue Constraints Guide.