Dosimetric and biological comparison of treatment plans between EDGE and CyberKnife systems in stereotactic body radiation therapy for localized prostate cancer

Aims: The aim of this study was to make a quantitative comparison of plan quality between MLC-based EDGE system and the cone-based CyberKnife system in stereotactic body radiation therapy (SBRT) for patients with localized prostate cancer.Materials and methods: Ten patients with prostate volumes ranging from 34.65 to 82.16 cc were used for prostate SBRT. Treatment plans were created for both EDGE and CyberKnife G4 systems using the same dose-volume constraints. Dosimetric indices including Planning Tumor Volume (PTV) coverage, conformity index (CI), new conformity index (nCI), homogeneity index (HI), gradient index (GI) were applied for target, while the sparing of critical organs, including bladder, rectum, femoral heads, urethra, penile bulk and normal tissue outside PTV), were evaluated interms of various dose-volume metrics and integral dose (ID). Meanwhile, the required delivery time and number of monitor units (MUs) during irradiation were measured to estimate the treatment efficiency. The radiobiological indices such as equivalent uniform dose (EUD), tumor control probability (TCP) and the normal tissue complication probability (NTCP) were also analyzed. Results: All dose constraints were achieved by both systems. It showed that the DEGE plans results were closest to the CK plans results in terms of PTV coverage, HI and GI. For EDGE, more conformal dose distribution in the target as well as reduced exposure of critical organs were obtained together with reduction of 91% delivery time and 72% monitor units. EDGE plans also got lower EUD for bladder, rectum, urethra and penile bulk, which associated with reduction of NTCPs. However, higher values of EUD and TCP for tumor were obtained with CK plans. Conclusions: Our study indicated that both systems were capable of producing almost equivalent plan quality and can meet clinical requirements. CyberKnife G4 system has higher target dose while EDGE system has more advantages based on the considerations of normal tissue sparing and delivery efficiency. With abundant clinical experience, CK provides accurate SBRT treatment with high quality. EDGE system also can be considered to be an option for SBRT treatment for localized prostate cancer treatment.