Sci-Thur AM: Planning - 12: Comparative study of SBRT lung dose calculation using Eclipse and Monte Carlo

Stereotactic Body Radiation Therapy (SBRT) is an option for early stage non-small cell lung cancer treatment. In SBRT treatment, high biological effective dose is delivered to the patient within a small number of fractions. High level of confidence in accuracy is required in the entire treatment procedure, from patient setup, tumour delineation, treatment simulation and planning, to the final dose delivery. SBRT lung treatment utilizes small fields that are incident on large tissue inhomogeneities within the patient. It is difficult for commercially available treatment planning systems (TPS) to model the lack of charged particle equilibrium and the dose near tissue-lung interfaces accurately. The Monte Carlo (MC) technique calculates the dose distribution from the first principles thereby providing a feasible tool for verifying the dose distribution computed from TPS. In this study, we compared the SBRT dose distribution between Eclipse 8.9 and BEAMnrc/DOSXYZnrc for both conformal and RapidArc plans. Calculation results for five clinical SBRT conformal lung plans were compared. Eclipse and MC results for each plan showed good agreement in dose received by organs at risk. MC simulation predicted uniformly hotter or similar PTV coverage for three cases with tumor either small or attached to the chest wall. When tumor is inside lung and at relatively medium to larger size for SBRT, MC predicted lower PTV coverage. The variation in dose coverage may depend on the tumour size and its position within the lung. Dose comparison for RapidArc plans shows similar dependence.