Effect of radiation protraction in intensity-modulated radiation therapy with direct aperture optimization: a phantom study.
The effect of radiation protraction in step-and-shoot IMRT is investigated for treatment plans created with the help of direct aperture optimization. The latter approach can be used during inverse planning for all clinical linear accelerators with conventional MLC. Direct aperture optimization significantly shortens fraction time for IMRT plans as compared to that for plans obtained by using the conventional inverse planning approach. By analyzing several IMRT plans obtained with direct aperture optimization we found that for alpha/beta ratio of 10 Gy (characteristic of fast growing tumors) the protraction effect is probably clinically insignificant for both conventional and large fraction sizes of 1.9 Gy and 5.7 Gy, respectively. For small alpha/beta of 1-1.5 Gy and conventional fraction size the effect of protraction is still small; however, this effect can be significant for hypofractionated treatments. Based on the obtained results it is recommended that, when possible, IMRT for slow growing prostate cancers be performed with small number of beams (e.g., 5) and small number of segments (e.g., 5-7 segments per beam) to reduce delivery time and, as a result, the associated effect of radiation protraction.
Kuperman
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JA Haley Medical Center, Tampa, FL 33612, USA. vadimkuperman@yahoo.com
Ventura
A M
AM
Sommerfeldt
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M
D019583:Dose Fractionation, Radiation; D016014:Linear Models; D009038:Motion; D019047:Phantoms, Imaging; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation* / Q000379:methods; D012680:Sensitivity and Specificity; D013997:Time Factors