title: Comparison of 6 MV and 18 MV photons for IMRT treatment of lung cancer.
abstract: OBJECTIVE
  To compare 6 MV and 18 MV photon intensity modulated radiotherapy (IMRT) for non-small cell lung cancer.
  
  
  METHODS
  Doses for a cohort of 10 patients, typical for our department, were computed with a commercially available convolution/superposition (CS) algorithm. Final dose computation was also performed with a dedicated IMRT Monte Carlo dose engine (MCDE).
  
  
  RESULTS
  CS plans showed higher D(95%) (Gy) for the GTV (68.13 vs 67.36, p=0.004) and CTV (67.23 vs 66.87, p=0.028) with 18 than with 6 MV photons. MCDE computations demonstrated higher doses with 6 MV than 18 MV in D(95%) for the PTV (64.62 vs 63.64, p=0.009), PTV(optim) (65.48 vs 64.83, p=0.014) and CTV (66.22 vs 65.64, p=0.027). Dose inhomogeneity was lower with 18 than with 6 MV photons for GTV (0.08 vs 0.09, p=0.007) and CTV (0.10 vs 0.11, p=0.045) in CS but not MCDE plans. 6 MV photons significantly (D(33%); p=0.045) spared the esophagus in MCDE plans. Observed dose differences between lower and higher energy IMRT plans were dependent on the individual patient.
  
  
  CONCLUSIONS
  Selection of photon energy depends on priority ranking of endpoints and individual patients. In the absence of highly accurate dose computation algorithms such as CS and MCDE, 6 MV photons may be the prudent choice.
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium. indira@krtkg1.ugent.be
authors.forename: Indira
authors.initials: I
authors.lastname: Madani
authors.forename: Barbara
authors.initials: B
authors.lastname: Vanderstraeten
authors.forename: Samuel
authors.initials: S
authors.lastname: Bral
authors.forename: Marc
authors.initials: M
authors.lastname: Coghe
authors.forename: Werner
authors.initials: W
authors.lastname: De Gersem
authors.forename: Carlos
authors.initials: C
authors.lastname: De Wagter
authors.forename: Hubert
authors.initials: H
authors.lastname: Thierens
authors.forename: Wilfried
authors.initials: W
authors.lastname: De Neve
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D017785:Photons; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted