RapidArc volumetric modulated therapy planning for prostate cancer patients

Recently, Varian Medical Systems have announced the introduction of a new treatment technique, RapidArc, in which dose is delivered over a single gantry rotation with dynamically variable MLC positions, dose rate and gantry speed. At Rigshospitalet, the RapidArc technique was brought into clinical practice in May 2008 for treatment of prostate cancer patients. We report here our experiences with performing treatment planning using the Eclipse RapidArc optimization software for this patient group.

A stand-alone installation of Eclipse 8.5 with RapidArc optimization capability was performed at Rigshospitalet. Patient data for 8 prostate cancer patients were imported, most of whom were previously treated at Rigshospitalet using IMRT. Three of the patients were treated at Rigshospitalet using the RapidArc technique. Treatment plans were optimized using objectives as given by standard guidelines for clinical treatment planning. RapidArc plans were compared to the IMRT plans by which the patients were actually treated or in the three cases treated with the RapidArc technique to IMRT plans achieved using standard guidelines. Comparison was done with respect to target coverage, doses to rectum and bladder, over-all maximum dose and number of monitor units.

Overall, the RapidArc treatment plans gave better or equal sparing of the organs at risk than the IMRT treatment plans. The number of monitor units was lower in most cases, by up to approximately 75%. However, the target dose homogeneity was not as high as for IMRT. The low-dose bath was larger than for IMRT.

RapidArc optimization is very promising, especially regarding the potential of reducing the number of monitor units, while providing good sparing of organs at risk. Some improvement is still warranted with respect to achieving high target dose homogeneity.