OncoTargets and Therapy (Jul 2017)
Volumetric modulated arc therapy for treatment of solid tumors: current insights
Abstract
Gabriella Macchia,1 Francesco Deodato,1 Savino Cilla,2 Silvia Cammelli,3 Alessandra Guido,3 Martina Ferioli,3 Giambattista Siepe,3 Vincenzo Valentini,4 Alessio Giuseppe Morganti,3,* Gabriella Ferrandina5,6,* 1Radiation Oncology Unit, 2Medical Physics Unit, “Giovanni Paolo II” Foundation, Catholic University of the Sacred Heart, Campobasso, 3Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, 4Department of Radiation Oncology, Catholic University of the Sacred Heart, Rome, 5Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, 6Department of Health Sciences and Medicine, University of Molise, Campobasso, Italy *These authors contributed equally to this work Aim: This article discusses the current use of volumetric modulated arc therapy (VMAT) techniques in clinical practice and reviews the available data from clinical outcome studies in different clinical settings. An overview of available literature about clinical outcomes with VMAT stereotactic/radiosurgical treatment is also reported.Materials and methods: All published manuscripts reporting the use of VMAT in a clinical setting from 2009 to November 2016 were identified. The search was carried out in December 2016 using the National Library of Medicine (PubMed/Medline). The following words were searched: “volumetric arc therapy”[All Fields] OR “vmat”[All Fields] OR “rapidarc”[All Fields], AND “radiotherapy”[All Fields] AND “Clinical Trial”[All Fields].Results: Overall, 37 studies (21 prospective and 16 retrospective) fulfilling inclusion criteria and thus included in the review evaluated 2,029 patients treated with VMAT; of these patients, ~30.8% had genitourinary (GU) tumors (81% prostate, 19% endometrial), 26.2% head-and-neck cancer (H&NC), 13.9% oligometastases, 11.2% had anorectal cancer, 10.6% thoracic neoplasms (81% breast, 19% lung), and 7.0% brain metastases (BMs). Six different clinical scenarios for VMAT use were identified: 1) BMs, 2) H&NC, 3) thoracic neoplasms, 4) GU cancer, 5) anorectal tumor, and 6) stereotactic body radiation therapy (SBRT) performed by VMAT technique in the oligometastatic patient setting.Conclusion: The literature addressing the clinical appropriateness of VMAT is scarce. Current literature suggests that VMAT, especially when used as simultaneous integrated boost or SBRT strategy, is an effective safe modality for all cancer types. Keywords: VMAT, RapidArc, clinical trial, review, radiosurgery, stereotactic, simultaneous integrated boost
