NTCP modeling analysis of acute hematologic toxicity in whole pelvic radiation therapy for gynecologic malignancies – A dosimetric comparison of IMRT and spot-scanning proton therapy (SSPT)

PurposeThis treatment planning study was conducted to determine whether spot scanning proton beam therapy (SSPT) reduces the risk of grade ⩾3 hematologic toxicity (HT3+) compared with intensity modulated radiation therapy (IMRT) for postoperative whole pelvic radiation therapy (WPRT).Methods and materialsThe normal tissue complication probability (NTCP) of the risk of HT3+ was used as an in silico surrogate marker in this analysis. IMRT and SSPT plans were created for 13 gynecologic malignancy patients who had received hysterectomies. The IMRT plans were generated using the 7-fields step and shoot technique. The SSPT plans were generated using anterior-posterior field with single field optimization. Using the relative biological effectives (RBE) value of 1.0 for IMRT and 1.1 for SSPT, the prescribed dose was 45 Gy(RBE) in 1.8 Gy(RBE) per fractions for 95% of the planning target volume (PTV). The homogeneity index (HI) and the conformity index (CI) of the PTV were also compared.ResultsThe bone marrow (BM) and femoral head doses using SSPT were significantly lower than with IMRT. The NTCP modeling analysis showed that the risk of HT3+ using SSPT was significantly lower than with IMRT (NTCP = 0.04 ± 0.01 and 0.19 ± 0.03, p = 0.0002, respectively). There were no significant differences in the CI and HI of the PTV between IMRT and SSPT (CI = 0.97 ± 0.01 and 0.96 ± 0.02, p = 0.3177, and HI = 1.24 ± 0.11 and 1.27 ± 0.05, p = 0.8473, respectively).ConclusionThe SSPT achieves significant reductions in the dose to BM without compromising target coverage, compared with IMRT. The NTCP value for HT3+ in SSPT was significantly lower than in IMRT.     

Study of efficiency in five-field and field-by-field intensity modulated radiation therapy (IMRT) plan using DOSXYZnrc Monte Carlo code

Implementation of a modern treatment technique, such as IMRT, has been improved. In line with that, Monte Carlo (MC) simulations of this technique require the ability of complex beam configurations modelling with respect to the patient. The source 20 DOSXYZnrc with the dynamic and step and shoot technique can be used to simulate the modality. However, they have a different process to obtain the dose distribution in a certain phantom. This study aimed to compare the simulation efficiency and isodose dose distribution in a water phantom from various beam angles and multileaf collimator (MLC) positions in an IMRT plan using source 20. The 30 × 30 × 30 cm³ phantom was irradiated by Varian Clinac iX10MV photon beam with various field sizes from 2 × 2 to 6 × 6 cm² using some beam angles 5°, 30°, 90°, 180°, and 300° and maintaining the source to surface distance (SSD) of 100 cm. The field-by-field and five-field methods were used to obtain the 3-dimensional (3D) dose distribution. The dose distribution of these methods was compared using the gamma index, DVH analysis, and simulation efficiency. Higher efficiency is better because it implies that it takes less time to reach a given uncertainty. The implementation of source 20 has been validated, with similar results, with validated source in DOSXYZnrc. The identical 3D-dimensions dose distributions using source 20 for dynamic and step and shoot were observed. Two simulations used the same number of histories with the statistical uncertainty of less than 3%. The step and shoot technique was more efficient than the dynamic simulation.