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Volume 22, Number 1, 2017

Dosimetric influence of filtered and flattening filter free photon beam on rapid arc (RA) radiotherapy planning in case of cervix carcinoma

Lalit Kumar, Girigesh Yadav, Kothanda Raman Samuvel, Manindra Bhushan, Pawan Kumar, Mahammood Suhail, Manoj Pal



To investigate the dosimetric influence of filtered and flattening filter free (FFF) photon beam of 6 and 10 MV energies on cervix RA radiotherapy planning and to find possibilities to develop the clinically acceptable RA plans with FFFB photon beam and explore their potential benefits to cervix cancer patients.


FFF photon beams enhances the treatment delivery by increased dose rate which results in shorter treatment time, this shorter treatment time reduces intrafraction motion and enhance comfort to the patients.

Materials and methods

RA plans were generated for filtered and flattening filter free photon beams of 6 and 10 MV energies using same dose–volumes constraints. RA plans were generated to deliver a dose of 50.4 Gy in 28 fractions, for a cohort of eleven patients reported with cervix carcinoma. RA plans were evaluated in terms of PTV coverage, dose to OAR's, CI, HI, total no. of monitor units (MUs) and NTID and low dose volume of normal tissues.


Clinically acceptable and similar plans were generated for filtered and flattening filter free photon beams. FFFB delivered slightly higher mean target dose (52.28 Gy vs. 52.0 Gy, p = 0.000 for 6 MV and 52.42 Gy vs. 52.0 Gy, p = 0.000 for 10 MV) less homogeneous (1.062 vs. 1.052, p = 0.000 for 6 MV and 1.066 vs. 1.051, p = 0.000 for 10 MV) and less conformal (1.007 vs. 1.004, p = 0.104 for 6 MV and 1.012 vs. 1.003, p = 0.010 for 10 MV) RA plans compared to FB. FFFB delivered more doses to the bladder and rectum, also required more numbers of MUs in comparison to FB.


This study concludes that FB is more beneficial for cervix RA planning in comparison to FFFB, as FB generates more conformal and homogenous rapid arc plans and offers better OAR's sparing.

Signature: Rep Pract Oncol Radiother, 2017; 22(1) : 10-18

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