Evaluation of plan quality and robustness of IMPT and helical IMRT for cervical cancer

Haijiao Shang,Yuehu Pu,Wei Wang,Zhitao Dai,Fu Jin

doi:10.1186/s13014-020-1483-x

Abstract

BackgroundBoth plan quality and robustness were investigated through comparing some dosimetric metrics between intensity modulated proton therapy (IMPT) and helical tomotherapy based intensity modulated radiotherapy (IMRT) for cervical cancer.MethodsBoth a spot-scanning robust (SRO) IMPT plan and a helical tomotherapy robust (TRO) IMRT plan were generated for each of 18 patients. In order to evaluate the quality of nominal plans without dose perturbations, planning scores (PS) on clinical target volume (CTV) and five organs at risk (OARs) based on clinical experience, and normal tissue complication probabilities (NTCP) of rectum and sigmoid were calculated based on Lyman-Kutcher-Burman (LKB) model. Dose volume histogram bands width (DVHBW) were calculated in 28 perturbed scenarios to evaluate plan robustness.ResultsCompared with TRO, the average scores of SRO nominal plans were higher in target metrics [V46.8Gy, V50Gy, Conformity and Homogeneity](16.5 vs. 15.1), and in OARs metrics (60.9 vs. 53.3), including bladder [V35,V45, Dmean,D2cc], rectum [V40,V45,D2cc,Dmax], bowel [V35,V40,V45, Dmax], sigmoid [V40,Dmax] and femoral heads [V30,Dmax]. Meanwhile, NTCP calculation showed that the toxicities of rectum and sigmoid in SRO were lower than those in TRO (rectum: 2.8% vs. 4.8%, p < 0.05; sigmoid: 5.2% vs. 5.7%, p < 0.05). DVHBW in target coverage for the SRO plan was smaller than that for the TRO plan (0.6% vs. 2.1%), which means that the SRO plan generated a more robust plan in target.ConclusionBetter CTV coverage and OAR Sparing were obtained in SRO nominal plan. Based on NTCP calculation, SRO was expected to allow a small reduction in rectal toxicity. Furthermore, SRO generated a more robust plan in CTV target coverage.

Highlights

Both plan quality and robustness were investigated through comparing some dosimetric metrics between intensity modulated proton therapy (IMPT) and helical tomotherapy based intensity modulated radiotherapy (IMRT) for cervical cancer
The difference was obvious for all organs at risk (OARs), which is consistent with results obtained in prostate studies [7]
The present study shows that normal tissue complication probabilities (NTCP) values for rectum and sigmoid in the proton plan are significantly lower in scanning robust (SRO) plans, which is consistent with previous studies [ref]

Summary

Introduction

Both plan quality and robustness were investigated through comparing some dosimetric metrics between intensity modulated proton therapy (IMPT) and helical tomotherapy based intensity modulated radiotherapy (IMRT) for cervical cancer. As an advanced modality of radiotherapy for intensity modulated radiation therapy (IMRT) combined with an image guiding system, helical tomotherapy (HT) has been proven to be efficient for cervical cancer [2]. CTV is expected to receive a prescribed dose as long as it stays within the PTV. This fundamental assumption does not always works, especially for IMPT, in which anatomical misalignment can lead to significant dose distortion at the edges of the PTV and even inside the planning target [8, 9]. A novel strategy to deal with the uncertainties is to develop a robust optimization algorithm instead of using PTV-based optimization, which has been reported to be effective in compensating for setup and range uncertainties in both proton and photon radiotherapy [10,11,12,13,14]

Methods

Results

Discussion

Conclusion