title: A dosimetric study of volumetric modulated arc therapy planning techniques for treatment of low-risk prostate cancer in patients with bilateral hip prostheses.
abstract: OBJECTIVE
  Recently, megavoltage (MV) photon volumetric modulated arc therapy (VMAT) has gained widespread acceptance as the technique of choice for prostate cancer patients undergoing external beam radiation therapy. However, radiation treatment planning for patients with metallic hip prostheses composed of high-Z materials can be challenging due to (1) presence of streak artifacts from prosthetic hips in computed tomography dataset, and (2) inhomogeneous dose distribution within the target volume. The purpose of this study was to compare the dosimetric quality of VMAT techniques in the form of Rapid Arc (RA) for treating low-risk prostate cancer patient with bilateral prostheses.
  
  
  METHODS
  Three treatment plans were created using RA techniques utilizing 2 arcs (2-RA), 3 arcs (3-RA), and 4 arcs (4-RA) for 6 MV photon beam in Eclipse treatment planning system. Each plan was optimized for total dose of 79.2 Gy prescribed to the planning target volume (PTV) over 44 fractions. All three RA plans were calculated with anisotropic analytical algorithm.
  
  
  RESULTS
  The mean and maximum doses to the PTV as well as the homogeneity index among all three RA plans were comparable. The plan conformity index was highest in the 2-Arc plan (1.19) and lowest in the 4-Arc plan (1.10). In comparison to the 2-RA technique, the 4-RA technique reduced the doses to rectum by up to 18.8% and to bladder by up to 7.8%. In comparison to the 3-RA technique, the 4-RA technique reduced the doses to rectum by up to 14.6% and to bladder by up to 3.5%.
  
  
  CONCLUSIONS
  Based on the RA techniques investigated for a low-risk prostate cancer patient with bilateral prostheses, the 4-RA plan produced lower rectal and bladder dose and better dose conformity across the PTV in comparison with the 2-RA and 3-RA plans.
authors.affiliation: Department of Medical Physics, ProCure Proton Therapy Center, Oklahoma City, OK, USA.
authors.forename: Suresh B
authors.initials: SB
authors.lastname: Rana
authors.affiliation: Department of Radiation Oncology, Premiere Oncology, Fort Myers, FL, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Pokharel
keywords: Avoidance sector; RapidArc; bilateral; prostate cancer; prosthesis; volumetric modulated arc therapy