Comparison of the dose distribution of the VMAT radiotherapy technique depending on the beam used: FFF-X10MV and FFF-X15MV

Background: The aim of the study was to answer the question of whether flattening filter (FF) and flattening filter-free (FFF) beams can be used alternately in the volumetric modulated arc therapy (VMAT) treatment technique, regardless of the size of the irradiated volume [small (S) or large (L) planning target volume (PTV)].Materials and methods: Two groups of patients were examined: a group with a S-PTV-laryngeal cancer and a group with a L-PTV - gynecological volume. For each patient, two treatment plans were made for beams (energies): FFF-X10MV and FF-X15MV. Then, a statistical analysis, nonparametric test, and independent groups were performed, comparing the beams' impact on the analyzed treatment plans.Results: In the case of laryngeal irradiation (S-PTV), there are no statistically significant differences between the energy used and the assessed parameters of the plan. In the case of gynecological volume (L-PTV), only statistically significant differences were noted for the number of monitor units depending on the energy used. For a large irradiated volume (gynecological case), the use of FFF beams increases the number of monitor units by 39,4% in relation to the FF beam.Conclusions: In the case of gynecological neoplasms, statistically significant differences were found in the number of monitor units. Therefore, in the case of irradiation of L-PTV, it is recommended that flattening-filtering beams are used due to the smaller number of monitors. In the case of S-PTV, no statistically significant differences were found between the types of beams used (FF or FFF) and the treatment plan parameters analyzed in the study.