Optimization of photon beam energy in aperture-based inverse planning

Optimal choice of beam energy in radiation therapy is easy in many well-documented cases, but less obvious in some others. Low-energy beams may provide better conformity around the target than their high-energy counterparts due to reduced lateral scatter, but they also contribute to overdosage of peripheral normal tissue. Beam energy was added as an optimization parameter in an automatic aperture-based inverse planning system. We have investigated two sites (prostate and lung), representative of deep-seated and moderately deep-seated tumors. For each case and different numbers of beam incidences, four plans were optimized: 6 MV, 23 MV, and mixed energy plans with one or two energies per incidence. Each plan was scored with a dose-volume cost function. Cost function values, number of segments, monitor units, dose-volume parameters and isodose distributions were compared. For the prostate and lung cases, energy mixing improved plans in terms of cost function values, with a more important reduction for a small number of beam incidences. Use of high energy allows better peripheral tissue sparing, while keeping similar target coverage and sensitive structures avoidance. Low energy contribution to monitor units usually increased with the number of beam incidences. Thus, for deep-seated and moderately deep-seated tumors, energy optimization can produce interesting plans with less peripheral dose and monitor units than for low energy alone.