1

Evgenia Nigay
DOS 773

IMRT SupaFirefly Esophagus Technique

Esophageal cancer can be treated using a simple 2D/3D technique or a more complex
IMRT technique. With traditional beam arrangements the heart is in the path of the beams, and
one concern when treating esophageal cancer is the cardiac toxicity. Matt Palmers power point
presentation discussed the techniques using alternative beam arrangements to help reduce the
effects of radiation on the heart. One technique that showed favorable results is the IMRT
SupaFirefly technique. For this assignment this technique will be compared to the VMAT
planning technique used to treat esophageal cancer at my clinic (Figures 1&2).

Figure 1. VMAT beam arrangement.

Figure 2. IMRT SupaFirefly beam arrangement.

The prescription was to deliver 50.4 Gy in 28 fractions; both techniques were planned
using 6 MV photons and the same optimization objectives. I did not use the provided planning
objectives since Eclipse treatment planning system uses a different optimizer format, but they
were useful as a guide when I was creating my own optimizer objectives. All of the organ at risk
(OAR) constraints were met and the PTV coverage was comparable between the two techniques.
SupaFirefly was superior over the VMAT technique in reducing the mean dose to the heart and
other OAR, except for the spinal cord (Figures 3&4). However, the maximum doses to these
organs were lower using VMAT.
 2

Figure 3. Dose to the OAR comparisons between the VMAT and SupaFirefly techniques.

Figure 4. Comparative DVH.

Both techniques have pros and cons. The VMAT plan delivers 515 MUs, reducing the
treatment time in half when comparted to the IMRT plan with 1,065 MUs. The plan is also more
 3

conformal with 2,936.55cc volume for the 50% isodose line, compared to the 3,686.31cc 50%
isodose line for the IMRT plan. However, with the VMAT plan there is more low-dose scatter,
with 9,364.25cc volume for the 25% isodose line vs. 8,035.74cc for the IMRT plan. Because
there are pros and cons to each technique its difficult to label one as superior over the other. The
SupaFirefly technique is definitely superior and useful when it comes to lowering the mean
dose to the heart, but overall both techniques are comparable.