Study of robustness of IMPT and IMRT for prostate cancer against organ movement

Intensity-modulated radiotherapy with photons (IMRT) and protons (IMPT) produces dose distributions that have high conformality to the planning target volume and sufficient sparing of the organs at risk if calculated on a single static computed tomography (CT) scan. For prostate cancer patients, organ movement with related changes to the density distribution in the irradiated volume occurs during the treatment course. We evaluated the sensitivity of IMPT and IMRT plans to organ movement.

IMPT and IMRT treatment plans were evaluated for 4 patients with an average of 16 CT data sets per patient. The treatment plans were recalculated on all treatment CT scans, and the dose was accumulated in the reference geometry using a deformable registration algorithm. Accurate dose calculation methods were applied for both IMPT and IMRT.

With IMPT, unacceptably low total doses in the gross tumor volume were observed for patients with gas in the rectum on the planning CT scan. To achieve a total equivalent uniform dose (EUD) and EUD spread similar to that with IMRT, two methods were crucial for IMPT-a rectal gas water-equivalent density overwrite in the original planning CT scan and initial beam weight setting to achieve a homogeneous dose distribution for the whole planning target volume for each field separately. An improvement in the total EUD for the prostate and rectal wall was also observed for IMRT with the water-equivalent density overwrite of the rectal cavities.

The sensitivities of IMPT and IMRT to organ movement are of the same order if appropriate planning strategies are applied. The latter is especially crucial for IMPT.