A Treatment Planning Comparison between Intensity Modulated Proton Therapy (IMPT) and Volumetric Modulated Arc Therapy (VMAT) for prostate cancer

Abstract

Introduction: We made a comparison between IMPT plans and VMAT plans for ten prostate cancer patients with the analysis of dosimetric quantities and EUD for both target volume and OARs.

Methods: Ten patients planned for VMAT were retrospectively replanned with scanned proton beams. Target and OARs were kept as originally delineated in photon plans with the assumption that the change in dose distribution is acceptable. The prescribed dose to the PTV is 74 Gy using an RBE of 1.1. The optimized VMAT plan of each case was normalized using the PTV coverage value obtained from the optimized IMPT plan. For the PTV and OARs, the dosimetric quantities were analyzed. Moreover, EUD with the exponential parameter a with a 95% confidence level was calculated for both the PTV and OARs.

Results: For the PTV, all the averaged dose metrics, including the mean dose, the median dose and the maximum dose, the HI and the EUD, in the IMPT plans were statistically (p0.05) better than those in the VMAT plans. The dose to the PTV from IMPT plans ranged from 69.14.7 to 79.01.1 Gy (RBE), while that from VMAT plans ranged from 68.0 2.8 to 81.6 1.3 Gy (RBE). The mean dose of 2.6 Gy (RBE) to the body from the IMPT plan was significantly (p=0.007) lower than the mean dose of 5.8 Gy (RBE) from the VMAT plans. For all OARs except for the rectum, in the low-to-medium dose region, the volumes receiving low doses in IMPT plans were statistically (p0.05) lower than those in VMAT plans. The IMPT plans show statistically (p0.05) superior dose sparing of the rectum and bladder in comparison to the VMAT plans at the Dmax, Dmean, and V30Gy indices and at all dosimetric indices.

Conclusions: The results show that the IMPT plans were statistically superior to the VMAT plans for both the PTV and OARs. IMPT plans produced a more homogeneous dose in the PTV. For OARs, the volumes receiving the low doses were statistically lower in IMPT plans than in VMAT plans.