In vivo quality assurance of volumetric modulated arc therapy for ano-rectal cancer with thermoluminescent dosimetry and image-guidance

Objective: To assess in vivo dose distribution using cone-beam computed tomography scans (CBCTs) and thermoluminescent dosimeters (TLDs) in patients with anal or rectal cancer treated with volumetric modulated arc therapy (VMAT). Methods: Intracavitary (IC) in vivo dosimetry (IVD) was performed in 11 patients using adapted endorectal probes containing TLDs, with extra measurements at the perianal skin (PS) for anal margin tumors. Measured doses were compared to calculated ones obtained from image fusion of CBCT with CT treatments plans. Results: A total of 55 IC and 6 PS measurements were analyzed. IC TLD median planned and measured does were 1.81 Gy (range, 0.25-2.02 Gy) and 1.82 Gy (range, 0.19-2.12 Gy), respectively. In comparison to the planned doses all IC TLD dose measurements differed by a median dose of 0.02 Gy (range, -0.11/+0.19 Gy, p = 0.102) (median difference of 1.1%, range -6.1%/+10.6%). Overall, 95% of IC measurements were within +/- 7.7% of the expected percentage doses and only 1 value was above +10%. For PS measurements, only one was not within +/- 7.7% of expected values (i.e., -8.9%). Conclusions: Image guidance using CBCT for IVD with TLDs is helpful to validate the delivered doses in patients treated with VMAT for ano-rectal tumors. (C) 2014 Elsevier Ireland Ltd. All rights reserved.