Stereotactic body radiation therapy planning with duodenal sparing using volumetric-modulated arc therapy vs intensity-modulated radiation therapy in locally advanced pancreatic cancer: A dosimetric analysis

Rachit Kumar, Aaron T. Wild, Mark A. Ziegler, Ted K. Hooker, Samson D. Dah, Phuoc T Tran, Jun Kang, Koren Smith, Jing Zeng, Timothy M. Pawlik, Erik Tryggestad, Eric Ford, Joseph M. Herman

Research output: Contribution to journalArticle


Stereotactic body radiation therapy (SBRT) achieves excellent local control for locally advanced pancreatic cancer (LAPC), but may increase late duodenal toxicity. Volumetric-modulated arc therapy (VMAT) delivers intensity-modulated radiation therapy (IMRT) with a rotating gantry rather than multiple fixed beams. This study dosimetrically evaluates the feasibility of implementing duodenal constraints for SBRT using VMAT vs IMRT. Non-duodenal sparing (NS) and duodenal-sparing (DS) VMAT and IMRT plans delivering 25Gy in 1 fraction were generated for 15 patients with LAPC. DS plans were constrained to duodenal Dmax ofmean, Dmax, D1cc, D4%, and V20Gy compared with NS plans (all p≤0.002). DS constraints compromised target coverage for IMRT as demonstrated by reduced V95% (p = 0.01) and Dmean (p = 0.02), but not for VMAT. DS constraints resulted in increased dose to right kidney, spinal cord, stomach, and liver for VMAT. Direct comparison of DS VMAT and DS IMRT revealed that VMAT was superior in sparing the left kidney (p

Original languageEnglish (US)
Pages (from-to)243-250
Number of pages8
JournalMedical Dosimetry
Issue number3
StatePublished - 2013
Externally publishedYes



  • Duodenal sparing
  • IMRT
  • Pancreatic cancer
  • VMAT

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

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