Highlights
- •Dose to the lung tumours differed when AAA plans were recalculated with AcurosXB.
- •AAA overestimated dose especially at the edge of the PTV, compared to AcurosXB.
- •Algorithm differences were larger in SBRT than in locally advanced treatment plans.
- •Most differences between the algorithms increased in deep inspiration breath hold.
- •Dose to the risk organs did not differ substantially between the algorithms.
Abstract
Purpose
Evaluating performance of modern dose calculation algorithms in SBRT and locally advanced
lung cancer radiotherapy in free breathing (FB) and deep inspiration breath hold (DIBH).
Methods
For 17 patients with early stage and 17 with locally advanced lung cancer, a plan
in FB and in DIBH were generated with Anisotropic Analytical Algorithm (AAA). Plans
for early stage were 3D-conformal SBRT, 45 Gy in 3 fractions, prescribed to 95% isodose
covering 95% of PTV and aiming for 140% dose centrally in the tumour. Locally advanced
plans were volumetric modulated arc therapy, 66 Gy in 33 fractions, prescribed to
mean PTV dose. Calculation grid size was 1 mm for SBRT and 2.5 mm for locally advanced
plans. All plans were recalculated with AcurosXB with same MU as in AAA, for comparison
on target coverage and dose to risk organs.
Results
Lung volume increased in DIBH, resulting in decreased lung density (6% for early and
13% for locally-advanced group).
In SBRT, AAA overestimated mean and near-minimum PTV dose (p-values < 0.01) compared
to AcurosXB, with largest impact in DIBH (differences of up to 11 Gy). These clinically
relevant differences may be a combination of small targets and large dose gradients
within the PTV.
In locally advanced group, AAA overestimated mean GTV, CTV and PTV doses by median
less than 0.8 Gy and near-minimum doses by median 0.4–2.7 Gy.
No clinically meaningful difference was observed for lung and heart dose metrics between
the algorithms, for both FB and DIBH.
Conclusions
AAA overestimated target coverage compared to AcurosXB, especially in DIBH for SBRT.
Keywords
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Article info
Publication history
Accepted:
November 18,
2018
Received in revised form:
November 1,
2018
Received:
March 19,
2018
Identification
Copyright
© 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
