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Sara Long
Clinical Practicum III
Esophagus Plan Comparison
Esophagus Plan Comparison

Introduction

The purpose of this activity is to make a comparison between two planning styles for an
esophagus case. The first case was planned using VMAT with two complete arcs. The second case was
planned using the IMRT “SupaFireFly”1 method. The “SupaFireFly” method uses seven static IMRT
fields (60, 80, 120, 140, 160, 180, and 200 degree gantry angles). Both plans are prescribed 50.4 Gy in 28
fractions, and normalized so that 100% of dose covers 95% of the PTV.

VMAT Plan

To achieve 95% PTV coverage the VMAT plan was normalized to the 95.2 isodose line. The
VMAT plan achieved good dose conformality. The hotspot for this plan is 56.77 Gy.
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Sara Long
Clinical Practicum III
Esophagus Plan Comparison
Below is the scorecard for the VMAT plan. All metrics were met. These values are derived from clinical
goals used in my clinic as well as RTOG0623.
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Sara Long
Clinical Practicum III
Esophagus Plan Comparison
“SupaFireFly” Plan

To achieve 95% PTV coverage the “SupaFireFly” plan was normalized to the 95.945 isodose
line. This plan shows more low dose spillage laterally. The hotspot for this plan is 55.55 Gy.

After several optimizations, lung dose and cord dose was lowered; however, lung dose was not lowered as
well as in the VMAT plan. The scorecard below shows that one metric for the lungs was not met.
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Sara Long
Clinical Practicum III
Esophagus Plan Comparison

Comparison

The DVH below displays the comparison between the two plans. The “SupaFireFly” method was
able to lower cord dose but caused dose spillage into the lungs where VMAT was able to out perform this
method. The VMAT plan offers less OAR dose overall.
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Sara Long
Clinical Practicum III
Esophagus Plan Comparison
Concluding Questions

Was the outcome of the "SupaFirefly" Esophagus technique superior than methods used in your
clinic?

The “SupaFireFly” method seems inferior to VMAT regarding OAR sparing. Static IMRT fields
cannot distribute dose around as well as VMAT. In my clinic, we regularly use VMAT to plan
esophagus cases due to the nature of the surrounding anatomy.

How does this technique compare?

The “SupaFireFly” method will likely not be my preferred IMRT planning method for esophagus
cases; however, I believe this beam arrangement would be helpful to know for any 3D esophagus
cases that I may plan. While this technique did lower cord dose, the static fields were not as
capable of distributing dose as well as arcs. Where dose was pushed away from a structure it
quickly amassed in another structure.

Was this arrangement helpful? Why or why not?

There were a few positives regarding the technique: beam setup was quick, and optimization was
more rapid for the static fields than for the VMAT arcs. I could also see myself trying this field
arrangement for 3D esophagus planning or other mediastinal plans.

References

1. Palmer M. Advances in Treatment Planning Techniques and Technologies for Esophagus Cancer.
PowerPoint presentation. The University of Texas MD Anderson Cancer Center.