33rd National Conference of Association of Medical Physicists of India

THEME: FRONTIERS IN MEDICAL PHYSICS - INNOVATIONS AND CHALLENGES

AMPICON 2012 : NOV 01, 2012 TO NOV 03, 2012

Jointly organized by Association of Medical Physicists of India, Kasturba Medical College, Mangalore, Shirdi Saibaba
Cancer Hospital & Research Center, Manipal, and Association of Medical Physicists of India (Karnataka Chapter)

VENUE: DR. TMA PAI INTERNATIONAL CONVENTION CENTER, M.G ROAD, MANGALORE - 575001. KARNATAKA STATE, INDIA

Abstract No: 12075306 Submit Date: Jul 03, 2012 STATUS: SUBMITTED

TITLE : IMRT to Locally Advanced Prostate Cancer An Investigation on Photon Beam Energies
SUBJECT : B. Modern Radiotherapy Treatment Planning

Submitted By: Mr. SENTHILNATHAN KALIYAPPAN

MEDICAL PHYSICIST, ACTION CANCER HOSPITAL..

Authors :, Mr. Senthilnathan Kaliyappan 2, Mr. Murali Rangaiyan 3

Affiliations: 1. Dept of Radiation oncology, Action Cancer Centre, New Delhi, 2. Anna University, Chennai

Objective: The goal of the research was to evaluate treatment plans of IMRT using 6 and 15 MV photon beams
for prostate cancer including lymph nodes.

Methods and Materials: In this retrospective study IMRT plans were generated with Eclipse TM treatment planning system for 5
prostate cancer cases. For each patient 4 types of plans were generated: Plan A (6X optimal) and B (15X optimal) are using 6MV and
15 MV photon beams respectively. The organs at risk (OAR) dose volume objectives and priorities were further iterated to achieve as
low dose as possible until D95% of the prostate PTV & nodal PTV are compromised. Further iteration of plans during optimization
phase to achieve as low dose as possible to OAR resulted in different dose-volume objectives and priorities employed in 6 MV (plan
A) and 15 MV (plan B). Subsequently the plans C and D were done by swapping the dose constraints as follows: Plan C and D are
using 15 MV and 6 MV photon beam but employing the final optimization parameters from plan A (6X optimal plan) and plan B
(15X optimal plan) respectively, without the further adjustment during optimization. For plan evaluation the cumulative dose-volume
histogram, homogeneity index, conformity index at various reference isodose lines, quality of coverage and dose to organs at risk
were analysed. Monitor units were assessed to compare the ability of delivering high-modulated fluence.

Results and Conclusion: Enhanced effect of critical organ sparing without compromising the PTV coverage was noted when
planning with higher energy. The maximum differences found on the rectum, bladder and bowel was 8.5%, 6.5% and 1.5% of
prescribed dose of 76 Gy which are less in higher energy than lower energy IMRT plans respectively. The novel strategy for
comparison of planning approach confirmed the findings while swapping the dose objectives causes increased homogeneity index of
up to 2.7% and 8% in prostate and nodal PTV, respectively with reduced quality of coverage in lower energy IMRT plans. We
conclude from this study that when there is a need for harder constraints on the critical organs without compromising tumour
coverage 15 MV photons has advantages over 6 MV photons for large pelvic volumes IMRT treatment.

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