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Main Author:	Sunil Kumar
Format:	Recurso digital
Language:	English
Published:	Zenodo 2025
Online Access:	https://doi.org/10.5281/zenodo.17285005
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Abstract Background: Head and neck cancers (HNC) pose significant challenges for radiotherapy due to their proximity to critical organs-at-risk (OARs). While intensity-modulated radiation therapy (IMRT) remains the gold standard for dose conformity, volumetric modulated arc therapy (VMAT) has emerged as a promising advancement, offering dynamic arc-based delivery with potential gains in efficiency and dosimetric precision. Objective: To compare the dosimetric performance of IMRT and VMAT in HNC radiotherapy, focusing on target coverage, OAR sparing, treatment efficiency, and plan quality. Methods: In this retrospective study, 40 patients with histologically confirmed head and neck squamous cell carcinoma (HNSCC) underwent dual planning (IMRT and VMAT) using identical target volumes and dose constraints. Dosimetric parameters including PTV coverage (D95%), mean/maximum OAR doses, homogeneity index (HI), conformity index (CI), and monitor units were analyzed. Statistical comparisons used paired t-tests (SPSS v26). Results: Both modalities achieved clinically acceptable PTV coverage. VMAT demonstrated superior dose conformity (CI: 1.16 vs. 1.18, p < 0.05) and homogeneity (HI: 0.050 vs. 0.056, p < 0.05) compared to IMRT. VART significantly reduced maximum doses to the spinal cord (27.61 vs. 28.71 Gy, p < 0.05) and PRV cord (31.39 vs. 32.58 Gy, p < 0.05), while lowering mean dose of mandible (62.13 vs. 65.13 Gy, p < 0.05) and mean of skin Dmax (65.01 vs. 65.81 Gy, p < 0.05). Conclusion: VMAT outperformed IMRT in HNC radiotherapy, delivering superior dose homogeneity, conformity, and OAR sparing while significantly shortening treatment time. These advantages position VMAT as the preferred modality for balancing efficacy with reduced toxicity risks in clinical practice.

if (filemtime($filename) + $maxlifetime < time()) { unlink($filename); $count++; } } return $count; } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ protected function saveSession($sessId, $data): bool { $sessFile = $this->path . '/sess_' . $sessId; if ($handle = fopen($sessFile, 'w')) { $return = false; // Lock the file for exclusive access to avoid issues with multiple // processes writing session simultaneously: if (flock($handle, LOCK_EX)) { $return = fwrite($handle, $data); // Make sure that there's no trailing data by truncating the file to // the correct length: ftruncate($handle, strlen($data)); fflush($handle); flock($handle, LOCK_UN); } fclose($handle); if ($return !== false) { return true; } } // If we got this far, something went wrong with the file output... // It is tempting to throw an exception here, but this code is called // outside of the context of exception handling, so all we can do is // echo a message.

// Anecdotal testing Today and Yesterday seems to indicate destroy() // is called by the garbage collector and everything is good. // Something to keep in mind though. return 0; } /** * Write function that is called when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ public function write($sessId, $data): bool { if ($this->writesDisabled) { return true; } return $this->saveSession($sessId, $data); } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ abstract protected function saveSession($sessId, $data): bool; }

* * @return void */ public function writeClose() { // The assumption is that we're using PHP's ext/session. // session_write_close() will actually overwrite $_SESSION with an // empty array on completion -- which leads to a mismatch between what // is in the storage object and $_SESSION. To get around this, we // temporarily reset $_SESSION to an array, and then re-link it to // the storage object. // // Additionally, while you _can_ write to $_SESSION following a // session_write_close() operation, no changes made to it will be // flushed to the session handler. As such, we now mark the storage // object isImmutable. $storage = $this->getStorage(); if (! $storage->isImmutable()) { $_SESSION = $storage->toArray(true); session_write_close(); $storage->fromArray($_SESSION); $storage->markImmutable(); } } /** * Attempt to set the session name * * If the session has already been started, or if the name provided fails * validation, an exception will be raised. * * @param string $name * @return SessionManager * @throws Exception\InvalidArgumentException */ public function setName($name) { if ($this->sessionExists()) { throw new Exception\InvalidArgumentException( 'Cannot set session name after a session has already started'

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