Dosimetric and Radiobiological Evaluation of Dose Volume Optimizer (DVO) and Progressive Resolution Optimizer (PRO) Algorithm against Photon Optimizer on IMRT and VMAT Plan for Prostate Cancer

Yon-Lae Kim; Jin-Beom Chung; Seong-Hee Kang; Keun-Yong Eom; Changhoon Song; In-Ah Kim; Jae-Sung Kim; Jeong-Woo Lee

doi:10.14316/pmp.2018.29.4.106

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Kim, Chung, Kang, Eom, Song, Kim, Kim, and Lee: Dosimetric and Radiobiological Evaluation of Dose Volume Optimizer (DVO) and Progressive Resolution Optimizer (PRO) Algorithm against Photon Optimizer on IMRT and VMAT Plan for Prostate Cancer

Original Article

Progress in Medical Physics 2018;29(4):106-114.

Published online: 19 January 2018

DOI: https://doi.org/10.14316/pmp.2018.29.4.106

Dosimetric and Radiobiological Evaluation of Dose Volume Optimizer (DVO) and Progressive Resolution Optimizer (PRO) Algorithm against Photon Optimizer on IMRT and VMAT Plan for Prostate Cancer

Yon-Lae Kim^∗, Jin-Beom Chung^†,, Seong-Hee Kang^†, Keun-Yong Eom^†, Changhoon Song^†, In-Ah Kim^†, Jae-Sung Kim^†, Jeong-Woo Lee^‡

^∗Department of Radiologic Technology, Choonhae College of Health Sciences, Ulsan

^†Department of Radiation Oncology, Seoul National University Bungdang Hospital, Seongnam

^‡Department of Radiation Oncology, Konkuk University Hospital, Seoul, Korea

Corresponding author Jin-Beom Chung (jbchung1213@gmail.com) Tel: 82-31-787-7654 Fax: 82-31-787-4019

Received 23 October 2018 Revised 23 November 2018 Accepted 30 November 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This study aimed to compare the performance of previous optimization algorithms against new a photon optimizer (PO) algorithm for intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans for prostate cancer. Eighteen patients with prostate cancer were retrospectively selected and planned to receive 78 Gy in 39 fractions of the planning target volume (PTV). All plans for each patient optimized with the dose volume optimizer (DVO) and progressive resolution optimizer (PRO) algorithms for IMRT and VMAT were compared against plans optimized with the PO within Eclipse version 13.7. No interactive action was performed during optimization. Dosimetric and radiobiological indices for the PTV and organs at risk were analyzed. The monitor units (MU) per plan were recorded. Based on the plan quality for the target coverage, prostate IMRT and VMAT plans using the PO showed an improvement over DVO and PRO. In addition, the PO generally showed improvement in the tumor control probability for the PTV and normal tissue control probability for the rectum. From a technical perspective, the PO generated IMRT treatment plans with fewer MUs than DVO, whereas it produced slightly more MUs in the VMAT plan, compared with PRO. The PO showed over potentiality of DVO and PRO whenever available, although it led to more MUs in VMAT than PRO. Therefore, the PO has become the preferred choice for planning prostate IMRT and VMAT at our institution.

Keywords: Optimization algorithm, Photon optimizer, IMRT, VMAT

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Fig. 1

Comparison of DVH of (a) PO versus DVO for IMRT plan and (b) PO versus PRO for VMAT plan. Solid lines correspond to PO while the dashed lines correspond to DVO and PRO used in the optimization.

Table 1.

Dose volume constraints used in this study for both volumetric modulated arc therapy and intensity modulated radiation therapy.

Structure	Function type	Physical dose (Gy)
Rectum	V_30%	<70
Rectum	^V_50%	<54.3
Bladder	V_30%	<70
Bladder	^V_50%	<54.3
Femoral heads	V_5%	<54.3
GTV	V_99%	>78
PTV	V_0%	<81.9
	^V_2%	<81
	V_97%	>76.5
	^V_99%	>74.1
Ring	D_max	<60

D_max, the maximum dose; V_xx%, the volume receiving dose of xx Gy (x% of the prescription dose).

Table 2.

Parameters used to calculate Niemierko's EUD-based TCP and NTCP.

Tissue	Volume Type	^a	γ₅₀	TCD50/ TD50	α/β
Prostate	Tumor	−13	2.2	67.5	1.5
Rectum	Normal	8.33	2.66	80	5.4
Bladder		2	3.63	80	7.5
Right FH		13	2.7	65	3
Left FH		13	2.7	65	3

FH, femoral head; α/β, Alpha-beta ratio.

Table 3.

Comparison of dosimetric index for PTV and OARs in IMRT plans optimized with DVO and PO, and VMAT plans optimized with PRO and PO.

Organ	Dosimetric Index	IMRT		VMAT
Organ	Dosimetric Index	DVO	PO	PRO	PO
PTV	D_mean (%)	100.90	101.39	101.30	101.69
	D_2% (%)	103.91	103.50	104.93	104.48
	D_95% (%)	95.79	98.30	96.16	97.33
	V_95% (%)	95.89	98.56	96.60	97.95
	HI	0.05	0.08	0.09	0.07
	CI	1.33	1.03	1.03	1.06
	CN	0.73	0.90	0.91	0.90
Bladder	D_mean (%)	33.18	33.10	28.95	30.43
	V_40% (%)	36.28	38.00	31.13	32.55
	V_70% (%)	22.32	19.89	16.89	17.62
Rectum	D_mean (%)	57.50	51.76	50.27	47.56
	V_10% (%)	88.41	89.40	88.15	86.60
	V_40% (%)	78.21	74.52	71.09	65.13
	V_60% (%)	51.82	34.66	32.79	29.90
	V_70% (%)	34.53	23.34	22.40	19.85
Right FH	D_mean (%)	31.83	28.33	27.97	27.25
Right FH	D_max (%)	56.90	57.08	48.68	47.11
Left FH	D_mean (%)	30.20	28.18	27.44	25.74
Left FH	D_max (%)	57.66	56.67	48.26	46.44

D_mean, the mean dose; D_max, the maximum dose; D_min, the minimum dose; D_95%, the dose received at least 95% volume; V_XX%, the volume received xx% of prescription dose; HI, homogeneity index; CI, conformity index; CN, conformal number.

Table 4.

Average and standard deviation of TCP and NTCP from DVHs of 20 patient plans using different optimization algorithms for IMRT and VMAT technique.

Radiobiological Index	Organ	IMRT		VMAT
Radiobiological Index	Organ	DVO Average (SD)	PO Average (SD)	PRO Average (SD)	PO Average (SD)
TCP (%)	PTV	84.49 (3.53)	86.00 (4.94)	84.31 (2.43)	86.27 (2.11)
NTCP (%)	Bladder	0.064 (0.150)	0.060 (0.184)	0.051 (0.181)	0.053 (0.176)
	Rectum	6.693 (3.297)	4.384 (2.325)	4.586 (2.219)	3.659 (2.199)
	Left FH	0.548 (1.418)	0.126 (0.337)	0.041 (0.119)	0.035 (0.103)
	Right FH	0.618 (1.835)	0.168 (0.514)	0.030 (0.080)	0.031 (0.088)

SD, standard deviation; FH, femoral head.

Table 5.

Average and standard deviation of total MUs and optimization time for different delivery techniques and optimization algorithms

Technical parameter	IMRT		VMAT
Technical parameter	DVO Average (SD)	PO Average (SD)	PRO Average (SD)	PO Average (SD)
MUs	604 (32)	555 (25)	439 (19)	452 (22)

SD, standard deviation; MUs, monitor units.

Table 6.

P-value of estimated parameters by statistical analysis on plans with DVO and PRO against PO for IMRT and VMAT.

Organ	Index	DVO vs PO	PRO vs PO
PTV	D_mean (%)	<.01	<.01
	D_2% (%)	<.01	<.01
	D_95% (%)	<.01	<.01
	V_95% (%)	<.01	<.01
	HI	<.01	<.01
	CI	<.01	<.01
	CN	<.01	0.03
	TCP	<.01	<.01
Bladder	D_mean (%)	0.64	<.01
	V_40% (%)	<.01	<.01
	V_70% (%)	<.01	<.01
	NTCP	0.03	<.01
Rectum	D_mean (%)	<.01	<.01
	V_10% (%)	<.01	<.01
	V_40% (%)	<.01	<.01
	V_60% (%)	<.01	<.01
	V_70% (%)	<.01	<.01
	NTCP	<.01	<.01
Right Femoral Head	D_mean (%)	<.01	0.11
	D_max (%)	0.78	0.02
	NTCP	0.91	0.53
Left Femoral Head	D_mean (%)	<.01	<.01
	D_max (%)	0.81	<.01
	NTCP	0.25	0.03
	MU	<.01	<.01

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