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Comparative Study
. 2014 Feb;87(1034):20130617.
doi: 10.1259/bjr.20130617. Epub 2013 Dec 6.

Simultaneous integrated boost to intraprostatic lesions using different energy levels of intensity-modulated radiotherapy and volumetric-arc therapy

C Onal  1 , S Sonmez, G Erbay, O C Guler, G Arslan
Affiliations
Comparative Study

Simultaneous integrated boost to intraprostatic lesions using different energy levels of intensity-modulated radiotherapy and volumetric-arc therapy

C Onal et al. Br J Radiol. 2014 Feb.

Abstract

Objective: This study compared the dosimetry of volumetric-arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) with a dynamic multileaf collimator using the Monte Carlo algorithm in the treatment of prostate cancer with and without simultaneous integrated boost (SIB) at different energy levels.

Methods: The data of 15 biopsy-proven prostate cancer patients were evaluated. The prescribed dose was 78 Gy to the planning target volume (PTV78) including the prostate and seminal vesicles and 86 Gy (PTV86) in 39 fractions to the intraprostatic lesion, which was delineated by MRI or MR-spectroscopy.

Results: PTV dose homogeneity was better for IMRT than VMAT at all energy levels for both PTV78 and PTV86. Lower rectum doses (V30-V50) were significantly higher with SIB compared with PTV78 plans in both IMRT and VMAT plans at all energy levels. The bladder doses at high dose level (V60-V80) were significantly higher in IMRT plans with SIB at all energy levels compared with PTV78 plans, but no significant difference was observed in VMAT plans. VMAT plans resulted in a significant decrease in the mean monitor units (MUs) for 6, 10, and 15 MV energy levels both in plans with and those without SIB.

Conclusion: Dose escalation to intraprostatic lesions with 86 Gy is safe without causing serious increase in organs at risk (OARs) doses. VMAT is advantageous in sparing OARs and requiring less MU than IMRT.

Advances in knowledge: VMAT with SIB to intraprostatic lesion is a feasible method in treating prostate cancer. Additionally, no dosimetric advantage of higher energy is observed.

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Figures

Figure 1.
Figure 1.
Representative image demonstrating intraprostatic lesion (a) in diffusion weighted MR scan and (b) coregistered MR and CT scans. (c) PTV86 and PTV78 are generated with given margins to intraprostatic lesion and prostate.
Figure 2.
Figure 2.
Representative axial CT slices showing 50% of prescribed dose distributions for (a) 6 MV, (b) 10 MV, (c)15 MV energy intensity-modulated radiotherapy (IMRT) plans and (d) 6 MV, (e) 10 MV, (f) 15 MV energy volumetric-arc therapy (VMAT) plans.
Figure 3.
Figure 3.
Representative axial CT slices showing 95% of prescribed dose distributions for (a) 6 MV, (b) 10 MV, (c) 15 MV energy intensity-modulated RT (IMRT) plans and (d) 6 MV, (e) 10 MV, (f) 15 MV energy volumetric-arc therapy (VMAT) plans.
Figure 4.
Figure 4.
Rectum doses at different energy levels (a–c) in intensity-modulated RT (IMRT) plans and (d–f) volumetric-arc therapy (VMAT) plans. Solid lines represent plans with simultaneous integrated boost (SIB, PTV86). Dashed lines represent plans without SIB.
Figure 5.
Figure 5.
Bladder doses at different energy levels (a–c) in intensity-modulated RT (IMRT) plans and (d–f) volumetric-arc therapy (VMAT) plans. Solid lines represent plans with simultaneous integrated boost (SIB, PTV86). Dashed lines represent plans without SIB.
See this image and copyright information in PMC

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