Purpose: We present planning and early clinical outcomes of a study of intensity-modulated radiotherapy (IMRT) for locally advanced prostate cancer. Methods and Materials: A total of 43 patients initially treated with an IMRT plan delivering 50 Gy to the prostate, seminal vesicles, and pelvic lymph nodes, followed by a conformal radiotherapy (CRT) plan delivering 20 Gy to the prostate and seminal vesicles, were studied. Dose-volume histogram (DVH) data for the added plans were compared with dose-volume histogram data for the sum of two CRT plans for 15 cases. Gastrointestinal (GI) and genitourinary (GU) toxicity, based on the Radiation Therapy Oncology Group scoring system, was recorded weekly throughout treatment as well as 3 to 18 months after treatment and are presented. Results: Treatment with IMRT both reduced normal tissue doses and increased the minimum target doses. Intestine volumes receiving more than 40 and 50 Gy were significantly reduced (e.g., at 50 Gy, from 81 to 19 cm 3 ; p = 0.026), as were bladder volumes above 40, 50, and 60 Gy, rectum volumes above 30, 50, and 60 Gy, and hip joint muscle volumes above 20, 30, and 40 Gy. During treatment, Grade 2 GI toxicity was reported by 12 of 43 patients (28%), and Grade 2 to 4 GU toxicity was also observed among 12 patients (28%). With 6 to 18 months of follow-up, 2 patients (5%) experienced Grade 2 GI effects and 7 patients (16%) experienced Grade 2 GU effects. Conclusions: Use of IMRT for pelvic irradiation in prostate cancer reduces normal tissue doses, improves target coverage, and has a promising toxicity profile. Ó

Background: For breast cancer patients, radiotherapy increases the risk of cardiac disease. Conventional three-dimensional conformal radiotherapy (3D-CRT) in deep inspiration breath-hold (DIBH) has demonstrated substantial reduction in cardiac doses as compared to treatment in free breathing. The purpose of this treatment planning study is to investigate if dynamic techniques in combination with DIBH could improve the quality of the treatment plans and further reduce the doses to the heart and other organs at risk for early-stage breast cancer patients. Material and methods: CT series in DIBH of 16 patients from a previous study were used. For each patient, treatment plans were generated with the following three techniques: 3D-CRT, tangential intensity-modulated radiotherapy (tIMRT) and volumetric modulated arc therapy with partial arcs (pVMAT). The treatment planning was performed focusing on planning target volume (PTV) coverage, V 95% >95%. Dose-volume histograms were calculated and compared. Doses to the heart, left anterior descending (LAD) coronary artery, ipsilateral and contralateral lung as well as the contralateral breast (CB) were assessed. Results: All plans fulfilled the criterion on PTV coverage. Compared to 3D-CRT, the dynamic plans obtained better dose homogeneity and conformity. The mean heart dose was similar for 3D-CRT and tIMRT, 1.3 and 1.1 Gy, respectively, but significantly higher for pVMAT, 1.6 Gy. The median V 25 Gy to the heart was 0% for all techniques. The LAD doses were generally lower with the dynamic techniques. The mean doses to the ipsi-and contralateral lung and CB were similar with tIMRT and 3D-CRT but significantly higher with pVMAT. V 20 Gy to the ipsilateral lung was significantly lower with tIMRT compared to 3D-CRT. Conclusion: tIMRT and 3D-CRT with DIBH are better techniques for sparing heart tissue and other organs at risk without compromising target coverage in early-stage breast cancer irradiation compared to VMAT.

Radiotherapy patients will from time to time be treated on another linac than originally planned due to service or logistical challenges. For patients treated with dynamic intensity modulated radiotherapy (IMRT), extra care should be taken to make sure the delivered dose remains as planned. Four linacs with the same type of dynamic multileaf collimator (MLC) were compared to find a general prediction of the potential dosimetric error caused by treating IMRT patients on another linac without recalculating the treatment plan. The MLC parameters, transmission and dosimetric leaf separation (DLS) were measured for all four linacs. The dynamic fields that were measured to find the DLS value were imported into the treatment planning system to compare the calculated and measured doses. Measured values of transmission and DLS were used directly in the calculations to obtain dose differences of less than 1% between the calculated and measured doses at the reference setup. The dosimetric discrepancy between the linacs was acceptable for all but one linac. Recalculation of the treatment plan therefore remains as standard procedure for this linac when a planned patient must switch linac during the course of treatment. The depth and field size dependences of the MLC parameters were also tested, finding dose differences of up to 4%.

For patient specific cases, the model can with good accuracy calculate 3D dose distributions both with and without respiratory motion, and evaluate the dosimetric effects.

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