Dosimetry estimation on variations of patient size in prostate volumetric-modulated arc therapy

This study investigated the dosimetric variations of the target and critical organs of patients who had weight loss associated with prostate volumetric-modulated arc therapy (VMAT). Five patients with prostate volumes ranging from 32-86.5 cm³ were selected from a group of 30 patients. Prostate VMAT plans were carried out on each patient using the 6-MV photon beam with a single 360° arc. Decrease of patient size as a result of weight loss was mimicked by contracting the patient's external contour in the anterior, left, and right directions with depths from 0.5-2 cm. Soft tissue excluded by the contracted external contour was replaced by air and the dose distribution was recalculated using the same beam geometry and dose prescription. Dose-volume histograms and dose-volume points such as D99% and D5% for the planning target volume (PTV), clinical target volume (CTV), rectum, bladder, and femoral heads were calculated with variations of reduced depth. In addition, the minimum, maximum, and mean doses for the target and critical organs were determined. PTV and CTV D99% were found to have increased 2.86 ± 0.30% per cm and 2.75 ± 0.38% per cm of reduced depth ranging from 0.5-2 cm. Moreover, the rectal and bladder D30% increased 2.20 ± 0.20% per cm and 2.31 ± 0.83% per cm, and the femoral head D5% increased 3.30 ± 0.11% per cm of reduced depth. Results from variations of the minimum, maximum, and mean doses of the PTV, CTV, rectum, bladder, and femoral heads showed that there was a >5% increase of dose when the reduced depth reached 2 cm. This study provided dosimetry estimation for radiation oncology staff to justify dose variations of the target and critical organs when patients' weight loss occurred in prostate VMAT. Dose variations >5% were seen when the patients' reduced depth was equal to 2 cm.