Effect of Photon-Beam Energy on VMAT and IMRT Treatment Plan Quality and Dosimetric Accuracy for Advanced Prostate Cancer

Purpose: The goal of the research was to evaluate treatment plan quality and dosimetric accuracy of volumetric modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) plans using 6, 10, and 15 MV photon beams for prostate cancer including lymph nodes. Methods: In this retrospective study, VMAT and IMRT plans were generated with the Pinnacle© treatment planning system (TPS) (V9.0) for 10 prostate cancer cases. Each plan consisted of two target volumes: PTV B included the prostate bed, PTV PC+LN contained PTV B and lymph nodes. For plan evaluation statistics, the homogeneity index, conformity index, mean doses, and near-max doses to organs at risk (OAR) were analyzed. Treatment time and number of monitor units were assessed to compare delivery efficiency. Dosimetric plan verification was performed with a 2D ionization chamber array placed in a full scatter phantom. Results: No differences were found for target and OAR parameters in low and high energy photon beam plans for both VMAT and IMRT. A slightly higher low dose volume was detected for 6 MV VMAT plans (normal tissue: D mean = 16.47 Gy) compared to 10 and 15 MV VMAT plans (D mean = 15.90 Gy and 15.74 Gy, respectively), similar to the findings in IMRT. In VMAT, > 96% of detector points passed the 3%/ 3 mm γ criterion; marginally better accuracy was found in IMRT (> 97%). Conclusion: For static and rotational IMRT, 15 MV photons did not show advantages over 6 and 10 MV high energy photon beams in large volume pelvic plans. For the investigated TPS and linac combination, 10 MV photon beams can be used as the general purpose energy for intensity modulation.