Chelsea Gehrig

DOS 773 Clinical Practicum III

University of Wisconsin- LaCrosse

Esophagus Plan Comparison

1. Was the outcome of the "SupaFirefly" Esophagus technique superior than

methods used in your clinic? 

The typical method for treating an esophagus case at my clinic is to utilize

VMAT. We would begin with 2 full rotational arcs, however, since the size of
these fields tend to be larger than the jaws will allow, a third arc is often added.
For my VMAT plan in this assignment, I used 3 full rotational arcs. The first 2
arcs have jaw settings that cover either side of the PTV to keep the X jaw size
within tolerance. The 3rd arc has the collimator turned to 85° and covers the PTV
entirely.

I planned the IMRT with the “SupaFirefly” esophagus technique, utilizing

gantry angles of 60°, 80°, 120°, 140°, 160°, 180°, and 200°.

The outcome of the IMRT plan was very comparable to the outcome of my
VMAT plan. I normalized both plans so 100% of the prescription dose covered
95% of the treatment volume (PTV_High) and used the same objectives in the
optimization process. The objectives provided by the physician and the
objectives I entered in the optimization are below.
Physician objectives:

Optimization Objectives:
 The VMAT plan that I came up with resulted in a D0.03cc (%) of 97.95%
to the heart, while the IMRT was slightly higher at 98.54%. However, both the
mean dose and the V50Gy (%) of the heart were slightly lower with IMRT than
VMAT. The dose to the lungs was also slightly lower in the IMRT plan than in the
VMAT plan. The VMAT plan resulted in lower dose values for the liver mean and
V30Gy (%) and the PRV of the spinal canal. My VMAT plan resulted in slightly
more coverage with a higher V95% (%) of PTV_High at 99.72% compared to the
99.62% for IMRT. Therefore, I would select the VMAT plan to be superior to the
IMRT plan, though the numbers are very close and comparable. These values
can be viewed in the figure below.
 2. How does this technique compare?

As I mentioned above, the plans are very comparable when looking at the
dose values. Below is a visual way to compare the plans side-by-side with the
VMAT plan on the left and IMRT on the right. The IMRT plan shows some of the
95% isodose extending outside of the PTV father than the VMAT. The 100%
color wash shows fewer cold spots at the superior portion of the PTV in the
VMAT plan and a higher hot spot in the IMRT plan at the anterior portion of the
PTV. The shapes of the OAR curves are also more favorable in the VMAT DVH.

Isodose lines:

95% color wash:

100% color wash:

IMRT DVH:

VMAT DVH:
3. Was this arrangement helpful? Why or why not?

This “SupaFirefly” technique was beneficial to learn about and practice with.
The outcome with this technique is very similar to that of the VMAT plan and I
believe both plans are clinically acceptable. The VMAT plan outcome is superior
to the IMRT, however, if a patient were unable to receive a VMAT plan due to
insurance or billing, the IMRT plan with the “SupaFirefly” technique would be an
acceptable alternative.