title: Dosimetric and physical comparison of IMRT and CyberKnife plans in the treatment of localized prostate cancer.
abstract: OBJECTIVE
  The aim of our study was the dosimetric and physical evaluation of the CK and IMRT treatment plans for 16 patients with localized prostate cancer.
  
  
  BACKGROUND
  Intensity modulated radiation therapy (IMRT) is one of the recent technical advances in radiotherapy. The prostate is a well suited site to be treated with IMRT. The challenge of accurately delivering the IMRT needs to be supported by new advances such as image-guidance and four-dimensional computed conformal radiation therapy (4DCRT) tomography. CyberKnife (CK) provides real time orthogonal X-ray imaging of the patient during treatment course to follow gold fiducials installed into the prostate and to achieve motion correlation between online acquired X-ray imaging and digital reconstructed radiographs (DRRs) which are obtained from planning computed tomography images by translating and rotating the treatment table in five directions.
  
  
  METHODS
  Sixteen IMRT and CK plans were performed to be compared in terms of conformity (CI), heterogeneity indices (HI), percentage doses of 100% (V100), 66% (V66), 50% (V50), 33% (V33) and 10% (V10) volumes of the bladder and rectum. Dose-volume histograms for target and critical organs, (CI) and indices (HI) and isodose lines were analyzed to evaluate the treatment plans.
  
  
  RESULTS
  Statistically significant differences in the percentage rectal doses delivered to V10, V33, and V50 of the rectum were detected in favor of the CK plans (p values; <0.001, <0.001 and 0.019, respectively). The percentage doses for V66 and V100 of the rectum were larger in CK plans (13%, 2% in IMRT and 21%, 3% in CK plans, respectively). Percentage bladder doses for V10 and V33 were significantly lower in CK plans [96% in IMRT vs 48% in CK (p < 0.001) and 34% in IMRT vs 24% in CK (p = 0.047)]. Lower percentage doses were observed for V50, V66 of the bladder for the IMRT. They were 5.4% and 3.45% for IMRT and 13.4% and 8.05% for CK, respectively. Median CI of planning target volume (PTV) for IMRT and CK plans were 0.94 and 1.23, respectively (p < 0.001).
  
  
  CONCLUSIONS
  Both systems have a very good ability to create highly conformal volumetric dose distributions. Median HI of PTV for IMRT and CK plans were 1.08 and 1.33, respectively (p < 0.001).
authors.affiliation: Anadolu Medical Center, Radiation Oncology, Anadolu Caddesi, No. 1 Gebze, 41400 Kocaeli, Turkey.
authors.forename: Cemile
authors.initials: C
authors.lastname: Ceylan
authors.affiliation: Anadolu Medical Center, Radiation Oncology, Anadolu Caddesi, No. 1 Gebze, 41400 Kocaeli, Turkey.
authors.forename: Nadir
authors.initials: N
authors.lastname: Kucuk
authors.affiliation: Anadolu Medical Center, Radiation Oncology, Anadolu Caddesi, No. 1 Gebze, 41400 Kocaeli, Turkey.
authors.forename: Hande
authors.initials: H
authors.lastname: Bas Ayata
authors.affiliation: Anadolu Medical Center, Radiation Oncology, Anadolu Caddesi, No. 1 Gebze, 41400 Kocaeli, Turkey.
authors.forename: Metin
authors.initials: M
authors.lastname: Guden
authors.affiliation: Anadolu Medical Center, Radiation Oncology, Anadolu Caddesi, No. 1 Gebze, 41400 Kocaeli, Turkey.
authors.forename: Kayihan
authors.initials: K
authors.lastname: Engin
keywords: CyberKnife; IMRT; Prostate; Radiosurgery