Colorectal cancer prognosis based on dietary pattern using synthetic minority oversampling technique with K-nearest neighbors approach.

Generally, a person's life span depends on their food consumption because it may cause deadly diseases like colorectal cancer (CRC). In 2020, colorectal cancer accounted for one million fatalities globally, representing 10% of all cancer casualties. 76,679 males and 78,213 females over the age of 59 from ten states in the United States participated in this analysis. During follow-up, 1378 men and 981 women were diagnosed with colon cancer. This prospective cohort study used 231 food items and their variants as input features to identify CRC patients. Before labelling any foods as colorectal cancer-causing foods, it is ethical to analyse facts like how many grams of food should be consumed daily and how many times a week. This research examines five classification algorithms on real-time datasets: K-Nearest Neighbour (KNN), Decision Tree (DT), Random Forest (RF), Logistic Regression with Classifier Chain (LRCC), and Logistic Regression with Label Powerset (LRLC). Then, the SMOTE algorithm is applied to deal with and identify imbalances in the data. Our study shows that eating more than 10 g/d of low-fat butter in bread (RR 1.99, CI 0.91-4.39) and more than twice a week (RR 1.49, CI 0.93-2.38) increases CRC risk. Concerning beef, eating in excess of 74 g of beef steak daily (RR 0.88, CI 0.50-1.55) and having it more than once a week (RR 0.88, CI 0.62-1.23) decreases the risk of CRC, respectively. While eating beef and dairy products in a daily diet should be cautious about quantity. Consuming those items in moderation on a regular basis will protect us against CRC risk. Meanwhile, a high intake of poultry (RR 0.2, CI 0.05-0.81), fish (RR 0.82, CI 0.31-2.16), and pork (RR 0.67, CI 0.17-2.65) consumption negatively correlates to CRC hazards.

ICON-P - A double-blind evaluation of quality improvements with individualized CONstraints from low-cost knowledge-based radiation therapy planning in prostate cancer.

Purpose: /Objective(S)A low-cost, prior knowledge-based individualized dose-constraint generator for organs-at-risk has been developed for prostate cancer radiation therapy (RT) planning. In this study, we aimed to evaluate the feasibility and improvements in organs-at-risk (OAR) doses in prostate cancer RT planning using this tool served on a web application. Materials And Methods: A set of previously treated prostate cancer cases planned and treated with generic constraints were replanned using individualized dose constraints derived from a library of cases with similar volumes of target, OAR, and overlap regions and served on the web-based application. The goal was to assess the reduction in mean dose, specified dose volumes (V59Gy, V56Gy, V53Gy, V47Gy, and V40Gy), and generalized equivalent uniform dose (gEUD) to the rectum and bladder. Planners and assessors were blinded to the initial achieved doses and penalties. Sample size estimation was based on improvement in V53Gy for the rectum and bladder with a paired evaluation. Results: Twenty-four patients were replanned. All the plans had a PTV D95 of at least 97% of the prescribed dose. The individualized OAR constraints could be met for 87.5% of patients for all dose levels. The mean dose, V59Gy, V53Gy, and V47Gy for the bladder was reduced by 7.5 Gy, 1.12%, 5.51%, and 10.53% respectively. Similarly for the rectum, the mean dose, V59Gy, V53Gy, V47Gy and was reduced by 5.5 Gy, 4.34%, 6.97%, and 11.61% respectively. All dose reductions were statistically significant. The gEUD of the bladder was reduced by 2.47 Gy (p < 0.001) and the rectum by 3.21 Gy (p < 0.001). Conclusion: Treatment planning based on individualized dose constraints served on a web application is feasible and leads to improvement at clinically important dose volumes in prostate cancer RT planning. This application can be served publicly for improvements in RT plan quality.

Dosimetric Comparison between Acuros XB (AXB) and Anisotropic Analytical Algorithm (AAA) in Volumetric Modulated Arc Therapy.

AIM: Dose calculation accuracy between Anisotropic Analytical Algorithm (AAA) and Acuros XB (AXB) for various megavoltage (MV) photon beams for both flattening filter (FF) and flattening filter free (FFF) beams and to validate the accuracy of these dose calculations using inhomogeneous phantom in volumetric modulated arc therapy (VMAT). MATERIAL AND METHODS: A Cheese Phantom having 20 holes that can be filled with all virtual water plugs or set of density calibration plugs  was used for VMAT planning using two different algorithms using either single or double arc. Further phantom was used  irradiate plan in linear accelerator and the point doses measured using a 0.053 cc A1SL ionization chamber along electrometer . Different plans, cylindrical shape, C-shaped and donut targets were planned 6MV, 10MV, 6FFF MV and 10FFF MV beam energy. RESULT: The minimum average mean dose difference was 1.2% for PTV structures between AAA and AXB (p=0.02). Apart from these structures, the following density plugs have a more than 2% difference in maximum dose with statistical significance. (i) Solid water (MD=6.1%, p=0.016), (ii) Bone 200 (2.3%, p=0.029), (iii) CB_30% (MD=2.4%, p=0.050) and (iv) Cortical bone (MD=4.3%, p=0.018). In 6MV FFF and 10 MV FFF plans, the difference between AAA and AXB was not statistically significant (Fig 3). The Conformity index for the AAA less than that of AXB, in all energies and for all the PTVs. The CI was better in AXB than AAA, but the CI was not having much variation due to changes in beam energies, particularly for Cylinder shaped PTV. CONCLUSION: All combinations of beam energy AAA showed higher values in the maximum dose than the Acuros XB, except for the lung insert. Nonetheless, AAA showed a higher mean dose than the Acuros XB. Differences between these two algorithms for most of the beam energies are minimal.

Effect of external tension on the wetting of an elastic sheet.

Recent studies of elastocapillary phenomena have triggered interest in a basic variant of the classical Young-Laplace-Dupré (YLD) problem: the capillary interaction between a liquid drop and a thin solid sheet of low bending stiffness. Here we consider a two-dimensional model where the sheet is subjected to an external tensile load and the drop is characterized by a well-defined Young's contact angle θ_{Y}. Using a combination of numerical, variational, and asymptotic techniques, we discuss wetting as a function of the applied tension. We find that, for wettable surfaces with 0<θ_{Y}<π/2, complete wetting is possible below a critical applied tension due to the deformation of the sheet in contrast with rigid substrates requiring θ_{Y}=0. Conversely, for very large applied tensions, the sheet becomes flat and the classical YLD situation of partial wetting is recovered. At intermediate tensions, a vesicle forms in the sheet, which encloses most of the fluid, and we provide an accurate asymptotic description of this wetting state in the limit of small bending stiffness. We show that bending stiffness, however small, affects the entire shape of the vesicle. Rich bifurcation diagrams involving partial wetting and "vesicle" solution are found. For moderately small bending stiffnesses, partial wetting can coexist with both the vesicle solution and complete wetting. Finally, we identify a tension-dependent bendocapillary length, λ_{BC}, and find that the shape of the drop is determined by the ratio A/λ_{BC}^{2}, where A is the area of the drop.

Dynamics of cooperative excavation in ant and robot collectives.

The solution of complex problems by the collective action of simple agents in both biologically evolved and synthetically engineered systems involves cooperative action. Understanding the resulting emergent solutions requires integrating across the organismal behavior of many individuals. Here, we investigate an ecologically relevant collective task in black carpenter ants Camponotus pennsylvanicus: excavation of a soft, erodible confining corral. These ants show a transition from individual exploratory excavation at random locations to spatially localized collective exploitative excavation and escape from the corral. Agent-based simulations and a minimal continuum theory that coarse-grains over individual actions and considers their integrated influence on the environment leads to the emergence of an effective phase space of behaviors, characterized in terms of excavation strength and cooperation intensity. To test the theory over the range of both observed and predicted behaviors, we use custom-built robots (RAnts) that respond to stimuli to characterize the phase space of emergence (and failure) of cooperative excavation. Tuning the amount of cooperation between RAnts, allows us to vary the efficiency of excavation and synthetically generate the entire range of macroscopic phases predicted by our theory. Overall, our approach shows how the cooperative completion of tasks can arise from simple rules that involve the interaction of agents with a dynamically changing environment that serves as both an enabler and a modulator of behavior.

Optimal policies for mitigating pandemic costs: a tutorial model.

There have been a number of pharmaceutical and non-pharmaceutical interventions associated with COVID-19 over the past two years. Various non-pharmaceutical interventions were proposed and implemented to control the spread of the COVID-19 pandemic. Most common of these were partial and complete lockdowns that were used in an attempt to minimize the costs associated with mortality, economic losses and social factors, while being subject to constraints such as finite hospital capacity. Here, we use a minimal model posed in terms of optimal control theory to understand the costs and benefits of such strategies. This allows us to determine top-down policies for how to restrict social contact rates given an age-structured model for the dynamics of the disease. Depending on the relative weights allocated to mortality and socioeconomic losses, we see that the optimal strategies range from long-term social-distancing only for the most vulnerable, partial lockdown to ensure not over-running hospitals, and alternating-shifts, all of which lead to significant reduction in mortality and/or socioeconomic losses. Crucially, commonly used strategies that involve long periods of broad lockdown are almost never optimal, as they are highly unstable to reopening and entail high socioeconomic costs. Using parameter estimates from data available for Germany and the USA early in the pandemic, we quantify these policies and use sensitivity analysis in the relevant model parameters and initial conditions to determine the range of robustness of our policies. Finally we also discuss how bottom-up behavioral changes affect the dynamics of the pandemic and show how they can work in tandem with top-down control policies to mitigate pandemic costs even more effectively.

Inhibition of Aldose Reductase by Novel Phytocompounds: A Heuristic Approach to Treating Diabetic Retinopathy.

Aldose reductase (ALR2) activation in the polyol pathway has been implicated as the primary mechanism for the progression of diabetic retinopathy. Most of the aldose reductase inhibitors (ARIs), used for the treatment of diabetic complications, were withdrawn due to ineffective treatment and adverse side effects caused by nonspecificity. Epalrestat, a carboxylic acid inhibitor, is the only ARI used for the treatment of diabetic neuropathy, though associated with minor side effects to 8% of the treated population. Our study exploited the interactions of Epalrestat-ALR2 crystal structure for the identification of specific phytocompounds that could inhibit human lens ALR2. 3D structures of plant compounds possessing antidiabetic property were retrieved from PubChem database for inhibition analysis, against human lens ALR2. Among the shortlisted compounds, Agnuside and Eupalitin-3-O-galactoside inhibited lens ALR2 with IC50 values of 22.4 nM and 27.3 nM, respectively, compared to the drug Epalrestat (98 nM), indicating high potency of these compounds as ALR2 inhibitors. IC50 concentration of the identified ARIs was validated in vitro using ARPE-19 cells. The in silico and in vitro approaches employed to identify and validate specific and potent ALR2 inhibitors resulted in the identification of phytocompounds with potency equal to or better than the ALR2 inhibiting drug, Epalrestat.

Biomarkers for Breast Adenocarcinoma Using In Silico Approaches.

This work elucidates the idea of finding probable critical genes linked to breast adenocarcinoma. In this study, the GEO database gene expression profile data set (GSE70951) was retrieved to look for genes that were expressed variably across breast adenocarcinoma samples and healthy tissue samples. The genes were confirmed to be part of the PPI network for breast cancer pathogenesis and prognosis. In Cytoscape, the CytoHubba module was used to discover the hub genes. For correlation analysis, the predictive biomarker of these hub genes, as well as GEPIA, was used. A total of 155 (85 upregulated genes and 70 downregulated genes) were identified. By integrating the PPI and CytoHubba data, the major key/hub genes were selected from the results. The KM plotter is employed to find the prognosis of those major pivot genes, and the outcome shows worse prognosis in breast adenocarcinoma patients. Further experimental validation will show the predicted expression levels of those hub genes. The overall result of our study gives the consequences for the identification of a critical gene to ease the molecular targeting therapy for breast adenocarcinoma. It could be used as a prognostic biomarker and could lead to therapy options for breast adenocarcinoma.

Moderately Hypofractionated Radiotherapy and Androgen Deprivation Therapy for High-risk Localised Prostate Cancer: Predictors of Long-term Biochemical Control and Toxicity.

AIMS: There is a paucity of long-term data on outcomes of high-risk prostatic adenocarcinoma after moderately hypofractionated radiotherapy with elective nodal treatment and long-term androgen deprivation therapy (ADT). We report long-term control and toxicity outcomes and analyse the predictors of failure and toxicity. MATERIALS AND METHODS: The records of 120 consecutive high-risk prostate cancer patients treated in a single institution between February 2012 and December 2016 were retrospectively analysed. A moderately hypofractionted radiotherapy (HypoRT) regimen of 60 Gy in 20 fractions over 4 weeks with simultaneous elective pelvic irradiation to 44 Gy in 20 fractions with intensity-modulated radiotherapy was used, together with long-term ADT with either orchiectomy or medical castration for a total duration of 2-3 years. We analysed biochemical control, metastasis-free survival and late toxicities and their predictive factors using survival analysis. RESULTS: Patients had locally advanced cancers (cT3 77.5%, median pretreatment prostate-specific antigen 30 ng/ml, Gleason score 8-10 in 45.8%). The median follow-up time was 70 months. The 3- and 5-year probability of freedom from biochemical progression was 93% and 80%, respectively. The 5-year probability of freedom from local relapse/intra-pelvic nodal relapse/distant metastases as the site of first failure was 96%/97%/86%, respectively. Gleason score 8-10 and medical ADT for 2-3 years (as opposed to orchidectomy) were independent risk factors for distant metastases. A total of 18 grade 2 and above late gastrointestinal toxicity events and a total of 23 grade 2 and above late genitourinary toxicity events were documented. Patients who underwent a transurethral resection of prostate prior to radiotherapy had worse urological toxicity. CONCLUSIONS: HypoRT with elective nodal treatment results in excellent pelvic control. Distant metastases are the primary mode of failure. Risk of metastases is associated with Gleason score and the duration of ADT. Late urinary toxicities are more common in those with prior transurethral resection of prostate.

Totimorphic assemblies from neutrally stable units.

Inspired by the quest for shape-shifting structures in a range of applications, we show how to create morphable structural materials using a neutrally stable unit cell as a building block. This unit cell is a self-stressed hinged structure with a one-parameter family of morphing motions that are all energetically equivalent. However, unlike kinematic mechanisms, the unit cell is not infinitely floppy and instead exhibits a tunable mechanical response akin to that of an ideal rigid-plastic material. Theory and simulations allow us to explore the properties of planar and spatial assemblies of neutrally stable elements, and solve the inverse problem of designing assemblies that can morph from one given shape into another. Simple experimental prototypes of these assemblies corroborate our theoretical results and show that the addition of switchable hinges allows us to create load-bearing structures. Altogether, totimorphs pave the way for structural materials whose geometry and deformation response can be controlled independently and at multiple scales.

Intensity modulated radiotherapy in anal canal squamous cell carcinoma: Implementation and outcomes.

OBJECTIVE: Concurrent chemoradiotherapy (CCRT) is the standard curative treatment option for nonmetastatic anal squamous cell carcinoma (SCC). Intensity modulated radiotherapy (IMRT) can reduce doses delivered to bowel and skin and reduce toxicities associated with conventional fields. Here, we present our institutional data on dosimetry, toxicity, and clinical outcomes with IMRT for anal cancer. MATERIALS AND METHODS: We analyzed 23 patients of anal SCC treated with curative-intent CCRT/radiation therapy alone, utilizing IMRT, between August 2011 and December 2016. The standard prescription dose was 54 Gy/27Fr/5.5 weeks, delivered in two phases, and concurrent chemotherapy with 5-fluorouracil and mitomycin-C. Acute and late toxicities and dosimetric data were compiled and analyzed. RESULTS: The median age was 65 years. Fourteen (60.7%) patients had Stage IIIC disease. Eighteen patients received concurrent chemotherapy. No patient had any treatment breaks. Grade 3 acute perianal dermatitis was recorded in 11 (47.8%) patients. Proctitis, diarrhea, and cystitis were limited to Grade 1 in 73.9%, 47.8%, and 8.6% patients, respectively. The only late Grade 2+ toxicities were gastrointestinal toxicities in 4 (17.4%) patients. Twenty (87%) patients had complete response at 6 months. The 3-year local control, nodal control, and distant metastases-free survival were 85.9%, 86.6%, 84.7%, respectively, with 3-year disease-free survival and overall survival of 63.4% and 81%, respectively. CONCLUSION: In this report on IMRT in anal cancer from India, treatment was well tolerated with lower acute toxicity than reported in other prospective studies. Long-term results are at par with other published studies.

Wetting and wrapping of a floating droplet by a thin elastic filament.

We study the wetting of a thin elastic filament floating on a fluid surface by a droplet of another, immiscible fluid. This quasi-2D experimental system is the lower-dimensional counterpart of the wetting and wrapping of a droplet by an elastic sheet. The simplicity of this system allows us to study the phenomenology of partial wetting and wrapping of the droplet by measuring angles of contact as a function of the elasticity of the filament, the applied tension and the curvature of the droplet. We find that a purely geometric theory gives a good description of the mechanical equilibria in the system. The estimates of applied tension and tension in the filament obey an elastic version of the Young-Laplace-Dupré relation. However, curvatures close to the contact line are not captured by the geometric theory, possibly because of 3D effects at the contact line. We also find that when a highly-bendable filament completely wraps the droplet, there is continuity of curvature at the droplet-filament interface, leading to seamless wrapping as observed in a 3D droplet.

Helical Radiotherapy in Early Laryngeal Cancers Could Lead to Excess Local Recurrence: Lessons From a Phase II Prospective Study.

AIMS: A prospective study was conducted to investigate the feasibility and efficacy of carotid-sparing intensity-modulated radiotherapy (CSIMRT) in early glottic cancers (EGC). MATERIALS AND METHODS: Eighteen patients underwent CSIMRT using helical tomotherapy to a dose of 55 Gy/20 fractions/4 weeks. Carotid intimal thickness (CIT) at prespecified carotid levels was measured using B-mode ultrasound at 6, 18 and 36 months. Serial changes in CIT were also measured in a control prospective cohort of 18 patients with head and neck cancers receiving bilateral neck nodal radiation over the same time period (54-60 Gy/30 fraction/6 weeks). The outcomes of 18 patients undergoing CSIMRT were compared against a retrospective consecutive cohort of 41 patients with EGC to confirm comparable local control. RESULTS: No significant CIT differences were identified between patients undergoing CSIMRT versus the control group. However, four patients in the CSIMRT group had a local recurrence between 8 and 39 months. In all patients the epicentre of the recurrence was noted at the anterior part of the larynx. The 5-year local recurrence-free survival was 75.1% (95% confidence interval 56.6-99.7%). By contrast, in the group of EGC patients treated without carotid sparing, local recurrence was noted only in a single patient (patient treated with helical tomotherapy) and the 5-year local recurrence-free survival was 97.1% (95% confidence interval 91.8-100%) (Log-rank P = 0.01). CONCLUSION: We failed to show the safety of CSIMRT using helical tomotherapy in this population of EGC patients. Use of CSIMRT also did not translate into a substantial reduction in CIT until 36 months. Use of CSIMRT using rotational arc techniques such as helical tomotherapy may be associated with a greater risk of local recurrence due to intrafractional motion interplay effects.

A Phase I/II Study of Stereotactic Hypofractionated Once-weekly Radiation Therapy (SHORT) for Prostate Cancer.

AIMS: Stereotactic radiation therapy has been investigated predominantly in patients with low-intermediate-risk disease. We conducted a clinical trial of stereotactic hypofractionated radiation therapy delivered in once-weekly fractions on patients with all-risk non-metastatic disease to test feasibility, acute toxicities and patient-reported outcomes. MATERIALS AND METHODS: In this phase I/II study, 30 patients with prostatic adenocarcinoma, any Gleason score, T1-4N0 and prostate-specific antigen ≤60 ng/ml were treated with volumetric intensity modulated arc radiation therapy to a dose of 35 Gy in five fractions delivered once weekly. Patients with high-risk disease also received elective nodal irradiation to a dose of 25 Gy in five fractions simultaneously. Androgen deprivation was offered to intermediate- and high-risk patients. The primary outcome was acute toxicity. Secondary outcome measures included biochemical control and late toxicity. Patient-reported outcomes were measured using the International Prostate Symptom Score and European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire (QLQ). RESULTS: All 30 patients completed treatment per-protocol. Most patients had T3 (60%) and Gleason 7 (50%) tumours. The median prostate-specific antigen was 17 ng/ml. High-risk disease was present in 20 patients (66.7%). There was a low incidence of acute toxicities (grade 2 + urinary 3.3%, grade 2 rectal 0%). Within the EORTC QLQ framework, only the urinary symptom score showed a clinically meaningful worsening from a mean of 20/100 at baseline to 34/100 at the end of treatment (P < 0.001), but reduced to 24/100 at 6 months (P = 0.08). With a median follow-up of 41.5 months, two patients each reported grade 2 late urinary and rectal toxicity. The 3- and 4-year biochemical control rates were 96.7 and 87.9%, respectively. CONCLUSION: In a cohort of mainly high-risk cancers, stereotactic once-weekly radiation therapy was easy to implement and well tolerated, with a low incidence of acute and late toxicity and excellent biochemical control.

Molecular docking based virtual screening of carbonic anhydrase IX with coumarin (a cinnamon compound) derived ligands.

It is of interest to design carbonic anhydrase IX (CAIX) inhibitors with improved features using molecular docking based virtual high through put screening of ligands. Coumarin (a cinnamon compound with pharmacological activity) is known as a potent phytal compound blocking tumor growth. Hence, a series of 17 coumarin derivatives were designed using the CHEMSKETCH software for docking analysis with CAIX. The catalytic site analysis of CAIX for binding with ligand molecules was completed using the SCHRODINGER package (2009). Thus, 17 ligands with optimal binding features with CAIX were selected following the calculation of ADME/T properties. We report ligands #41, #42, #19 and #15 showed good docking score, glide energy and hydrogen bond interactions without vdW clash. We further show that N-(3,4,5-trimethoxy-phenylcarbamoylmethyl) designated as compound #41 have the highest binding energy (-61.58) with optimal interactions with the catalytic residues (THR 199, PRO 201, HIS 119, HIS 94) of CAIX.

Continuous hyperfractionated accelerated radiotherapy using modern radiotherapy techniques for nonsmall cell lung cancer patients unsuitable for chemoradiation.

INTRODUCTION: The continuous hyperfractionated and accelerated radiotherapy (CHART) regimen of radiotherapy (RT) for nonsmall cell lung cancer is underused outside the UK. We present the first Indian experience of using CHART for patients, who were not suitable for chemotherapy or concurrent chemo-RT. METHODS: We retrospectively reviewed the data of patients treated using CHART at our institution between January 2014 and December 2015. RESULTS: Thirty-seven patients were treated using CHART. Planning methods and dosimetry parameters are described. Three-dimensional conformal RT was used for treatment planning and delivery in 23 patients and volumetric modulated arc RT was necessary for 14 patients. Patients in our series had a median age of 70 years (interquartile range 65.50-74.00) and 86.5% had Stage III disease. Median follow-up was short at 13.0 months. Actuarial rates of 1-year progression-free survival, 1-year overall survival (OS), and 2-year OS were 31.9%, 59.5%, and 28.5%, respectively. This treatment was well tolerated with manageable and some reversible acute esophageal toxicity (91.9% CONCLUSION: Our results indicate that CHART is feasible, safe, and well tolerated in Indian patients who are clinically found to be not suitable for either sequential or concurrent chemo- RT.

Actual gains in dosimetry and treatment delivery efficiency from volumetric modulated arc radiotherapy for inoperable, locally advanced lung cancer over five-field forward-planned intensity-modulated radiotherapy.

AIMS: Volumetric modulated arc radiotherapy (VMAT) is used for inoperable, locally advanced nonsmall cell lung cancer, where three-dimensional conformal radiotherapy (3D-CRT) cannot yield an acceptable plan. METHODS: The planning and treatment data were prospectively collected on the first 18 patients treated using VMAT plans. We analyzed the actual dosimetric gain and impact on treatment, compared with complex multisegment 3D-CRT (five-field forward-planned intensity-modulated radiotherapy [IMRT]) that were generated for treatment. Proportion of planning target volume (PTV) receiving 95% dose (PTV-V95%) conformity index (CI), conformity number (CN), dose homogeneity index (DHI), monitor units (MUs), and treatment time were also analyzed. RESULTS: The PTV coverage (PTV-V95%) was improved from a median of 91.41% for 5-F forward-IMRT to 98.25% for VMAT (P < 0.001). The CI improved with a mean of 1.12 for VMAT and 1.31 for 5-F forward-IMRT (P < 0.001). The mean DHI improved from 1.15 for forward-IMRT to 1.08 for VMAT (P < 0.001). The mean CN improved from 0.62 for forward-IMRT to 0.87 for VMAT (P < 0.001). No significant increase in the low-dose bath (V5, V10 and mean lung dose) to the lung was seen. Significantly higher number of MUs (P < 0.001) and shorter treatment delivery times (P = 0.03) were seen with VMAT. CONCLUSION: VMAT resulted in improvement in target volume coverage, demonstrated by PTV-V95%, CI, CN, and DHI, without any increase in the low-dose bath to the lung. For conventional fractionation, VMAT requires more MUs (P < 0.001) but has a shorter treatment delivery time (P = 0.03) per fraction.