Static and rotational step-and-shoot IMRT treatment plans for the prostate: A risk comparison study

Abstract

For certain clinical applications, rotational intensity modulated radiation therapy (R-IMRT) techniques such as volumetric modulated arc therapy (VMAT) are capable of improved target dose coverage and shorter delivery time when compared to static, step-and-shoot IMRT. The authors performed a risk comparison study for two standard step-and-shoot IMRT plans and two step-and-shoot Rotational IMRT plans that were designed specifically for a Siemens Primus linear accelerator. CT images of a RANDO phantom were used to generate R-IMRT and static IMRT plans. One simple and one complex prostate cases were created to investigate these techniques. The R-IMRT plans consisted of 72 single-segmented 6 MV beams, equally spaced with beam angle separations of 5°. The static IMRT plans employed seven multisegmented 6 MV beams. Both types of plans were optimized in Pinnacle(3) with the direct machine parameter optimization (DMPO) algorithm using the same set of optimization objectives. The plans were delivered to a RANDO phantom and thermoluminescent diode (TLD) dose measurements were performed at various locations throughout the phantom. Risk coefficients and organ weightings as defined by International Commission on Radiological Protection (ICRP) Publication 103 were used to calculate the resulting effective doses to various organs at risk, as well as the overall risk estimate for both techniques. For the simple prostate case, the R-IMRT technique provided a higher dose to organs at risk within the CT volume and a lower overall peripheral dose to remaining organs. The R-IMRT plan had a risk estimate of 4.56% when compared to the IMRT risk of 4.78%. For the complex prostate case, there was no significant difference in the lifetime risks of the IMRT (5.73%) and R-IMRT (5.74%) plans. R-IMRT is an approximation to VMAT and it was found that there is no clinically significant difference between lifetime risk estimates between R-IMRT and standard seven-beam IMRT for the prostate.