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Lung Cancer Research Studies / Radiation Therapy and Dosimetry / Advanced Radiotherapy Techniques · Journal article
Physica Medica · August 12, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a retrospective dosimetric modelling study comparing constant versus variable dose-rate algorithms for estimating blood dose during VMAT in NSCLC. The four-dimensional algorithm showed statistically significant but small differences in blood dose metrics (D98% decreased 0.1 Gy, D2% increased 0.1 Gy), with mean blood dose remaining unchanged. The findings are methodologically sound but lack prospective validation or clinical outcome correlation to establish whether these dosimetric differences translate to altered haematological toxicity risk.
Retrospective dosimetric modelling cohort study. NSCLC patients who received VMAT; prescribed doses 50 Gy in 25 fractions, 55 Gy in 20 fractions, or 60 Gy in 30 fractions; treatment delivered 2018–2024.. Intervention: Volumetric modulated arc therapy (VMAT) with four-dimensional dose delivery algorithm (variable dose rates) for blood dosimetry estimation.. Compared with: Original algorithm using constant dose rates for blood dosimetry estimation.. n = 115. Single centre (not specified in abstract)..
Population blood D98% decreased by median ΔD98% = −0.1 Gy with variable versus constant dose rates (p < 0.001) Blood D2% increased by median ΔD2% = 0.1 Gy with variable dose rates (p < 0.001) Mean blood doses were similar in both calculations (median 5.4 Gy, p = 0.3)
No prospective data or clinical outcome measurement; surrogate endpoint only (dosimetry, not toxicity). Biological relevance of 0.1–0.38 Gy differences in blood D98%/D2% to haematological toxicity risk not determined.
This dosimetric analysis provides technical insight into blood dose distribution during VMAT but does not directly inform clinical decision-making. The small absolute differences in dose metrics (0.1 Gy median change) and the lack of toxicity correlation require prospective validation before any treatment modification can be recommended.
A methodological study implementing a novel four-dimensional dosimetry algorithm in a retrospective cohort; it demonstrates technical feasibility and reports dosimetric differences but lacks clinical outcome validation or prospective design.
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This dosimetric analysis provides technical insight into blood dose distribution during VMAT but does not directly inform clinical decision-making. The small absolute differences in dose metrics (0.1 Gy median change) and the lack of toxicity correlation require prospective validation before any treatment modification can be recommended.
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Introduction Volumetric modulated arc therapy (VMAT) for non-small cell lung cancer (NSCLC) may result in radiation-induced haematological toxicities. To estimate the dose received by circulating blood particles, we implemented a four-dimensional dose delivery algorithm into a stochastic simulation of blood dynamics. Methods The treatment data of NSCLC patients who received VMAT between 2018 and 2024 were considered. The prescribed dose was 60 Gy/55 Gy/50 Gy delivered in 30/20/25 fractions. To estimate the blood dose, the doses at each control point calculated with the BeamSplitter were used in the Haematological Dose software (HEDOS). The blood dose metrics D98%/mean dose/D2% were calculated and compared with the four-dimensional algorithm (variable dose rates) and the original algorithm (constant dose rates). The main organs contributing to the blood dose were reported. Results The cohort consisted of 115 treatments of 98 patients. As compared with constant dose rates, the population blood D98% decreased (median ΔD98% = −0.1 Gy, p-value < 0.001) with variable dose rates, whilst blood D2% increased (median ΔD2% = 0.1 Gy, p-value < 0.001). The mean blood doses were similar in both calculations (median mean blood dose = 5.4 Gy, p-value = 0.3). At the population level, the largest change in blood D2% was 0.38 Gy. The main organs contributing to the blood dose were lungs (25%), brachiocephalic veins (14%), and aorta (12%). Conclusions VMAT for NSCLC induced a larger blood D2% and a smaller blood D98% as compared with constant delivery.
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