Implementation of a wedged-dynamic arc therapy technique for head and neck cancer.

Introduction: In this study, we designed and evaluated a wedged dynamic arc therapy (W-DAT) to provide the desirable concaved-shape dose distribution to cover the target in the treatment of head and neck sequence cell carcinoma. Materials and Methods: Eight patients were treated using W-DAT. The dose prescriptions were 70 Gy and 54 Gy, in 35 fractions, to the sites of the gross planning target volume (PTV1) and the microscopic (PTV2) diseases respectively. This technique consists of four wedged half-arcs of moving multi-leaf collimator leaves to fit PTV1 and shield brain stem at all gantry rotations. These were combined with two anterior-posterior conformal fields of different weighing to improve the dose uniformity. Another two anterior-posterior conformal fields were designed to cover the PTV2. All of the eight fields were half blocked by the normal jaws so there is no dose overlap at the interface between the two targets. Results: Referring to radiation therapy oncology group protocol 0615, 95% of the PTV1 was covered by more than 95% (66.50 Gy) of the prescribed dose, with very low dose inhomogeneity index of 0.0670 ± 0.0007. The maximum dose to 1% of the planning organ at risk volumes-brainstem didn't exceed 56.10 ± 2.17 Gy while the two parotids were well spared as they received a mean dose of 21.97 ± 3.24 Gy. Isocentric ion chamber measurements showed good agreement with the treatment planning system calculated dose with the maximum deviation of 2.40% while film measurements yielded lesser than 4.20% of the pixels failed the acceptance gamma criteria of (3 mm, 3%). Conclusion: W-DAT technique was approved in our department as the standard choice for the radical treatment of head and neck sequence cell carcinoma.