title: A method for increased dose conformity and segment reduction for SMLC delivered IMRT treatment of the prostate.
abstract: OBJECTIVE
  The focus of this work is to develop a practical planning method that results in increased dose conformity and reduced treatment time for segmental multileaf collimation (sMLC) based intensity-modulated radiation therapy (IMRT) delivery.
  
  
  METHODS
  Additional regions for dose constraint are introduced within the normal tissue during the planning process by designing a series of concentric ellipsoids around the target. A dose gradient is then defined by assigning dose constraints to each concentric region. The technique was tested at two centers and data for 26 and 10 patients, respectively, are presented allowing for differences in treatment technique, beam energy, ellipsoid definition, and prescription dose. At both centers, a series of patients previously treated for prostate cancer with IMRT were selected, and comparisons were made between the original and new plans.
  
  
  RESULTS
  While meeting target dose specifications and normal tissue constraints, the average number of beam directions decreased by 1.6 with a standard error (SE) of 0.1. The average time for delivery at center 1 decreased by 29.0% with an SE of 2.0%, decreasing from 17.5 min to 12.3 min. The average time for delivery at center 2 decreased by 29.9% with an SE of 3.8%, decreasing from 11 min to 7.7 min. The amount of nontarget tissue receiving D(100) decreased by 15.7% with an SE of 2.4%. Nontarget tissue receiving D(95), D(90), and D(50) decreased by 16.3, 15.1, and 19.5%, respectively, with SE values of approximately 2% at center 1. Corresponding values for D(100), D(95), D(90), and D(50) decreased by 13.5, 16.7, 17.1, and 5.1%, respectively, with SE values of less than 3% at center 2.
  
  
  CONCLUSIONS
  By designating subsets of tissue as concentric regions around the target(s) and carefully defining each region's dose constraints, we have gained an increased measure of control over the region outside the target boundaries. This increased control manifests as two distinct endpoints that are beneficial to the IMRT process: increased dose conformity and decreased treatment time.
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA. r.price@fccc.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Price
authors.forename: Scott
authors.initials: S
authors.lastname: Murphy
authors.forename: Shawn W
authors.initials: SW
authors.lastname: McNeeley
authors.forename: C-M Charlie
authors.initials: CM
authors.lastname: Ma
authors.forename: Eric
authors.initials: E
authors.lastname: Horwitz
authors.forename: Benjamin
authors.initials: B
authors.lastname: Movsas
authors.forename: Adam
authors.initials: A
authors.lastname: Raben
authors.forename: Alan
authors.initials: A
authors.lastname: Pollack
mesh_terms: D000465:Algorithms; D006801:Humans; D008297:Male; D018579:Patient Selection; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D011859:Radiography; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D012007:Rectum; D001743:Urinary Bladder