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Multi-institutional comparison of volumetric modulated arc therapy vs. intensity-modulated radiation therapy for head-and-neck cancer: a planning study

Andrea Holt17, Dirk Van Gestel2, Mark P Arends3, Erik W Korevaar4, Danny Schuring5, Martina C Kunze-Busch6, Rob JW Louwe68 and Corine van Vliet-Vroegindeweij1*

Author Affiliations

1 Department of Radiation Oncology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, CX 1066, The Netherlands

2 Department of Radiation Oncology, Antwerp University Radiotherapy, UZA/ZNA, Antwerp, Belgium

3 Radiotherapeutic Institute Friesland, Leeuwarden, The Netherlands

4 Department of Radiation Oncology,University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

5 Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands

6 Department of Radiation Oncology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands

7 Present address: Department of Radiation Oncology, University of Duisburg-Essen, Essen, Germany

8 Present address: Department of Radiation Oncology, Wellington Blood and Cancer Centre, Wellington, New Zealand

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Radiation Oncology 2013, 8:26  doi:10.1186/1748-717X-8-26

Published: 31 January 2013



Compared to static beam Intensity-Modulated Radiation Therapy (IMRT), the main advantage of Volumetric Modulated Arc Therapy (VMAT) is a shortened delivery time, which leads to improved patient comfort and possibly smaller intra-fraction movements. This study aims at a treatment planner-independent comparison of radiotherapy treatment planning of IMRT and VMAT for head-and-neck cancer performed by several institutes and based on the same CT- and contouring data.


Five institutes generated IMRT and VMAT plans for five oropharyngeal cancer patients using either Pinnacle3 or Oncentra Masterplan to be delivered on Elekta linear accelerators.


Comparison of VMAT and IMRT plans within the same patient and institute showed significantly better sparing for almost all OARs with VMAT. The average mean dose to the parotid glands and oral cavity was reduced from 27.2 Gy and 39.4 Gy for IMRT to 25.0 Gy and 36.7 Gy for VMAT, respectively. The dose conformity at 95% of the prescribed dose for PTVboost and PTVtotal was 1.45 and 1.62 for IMRT and 1.37 and 1.50 for VMAT, respectively. The average effective delivery time was reduced from 13:15 min for IMRT to 5:54 min for VMAT.


Independently of institution-specific optimization strategies, the quality of the VMAT plans including double arcs was superior to step-and-shoot IMRT plans including 5–9 beam ports, while the effective treatment delivery time was shortened by ~50% with VMAT.

Head-and-neck cancer; Simultaneous integrated boost; Volumetric modulated arc therapy; Intensity-modulated radiation therapy; Multi-institutional collaboration; SmartArc