A comparison of three commercial IMRT treatment planning systems for selected pediatric cases

This work aimed at evaluating the performance of three different intensity-modulated radiotherapy (IMRT) treatment planning systems (TPSs) - KonRad, XiO and Prowess - for selected pediatric cases. For this study, 11 pediatric patients with different types of brain, orbit, head and neck cancer were selected. Clinical step-and-shoot IMRT treatment plans were designed for delivery on a Siemens ONCOR accelerator with 82-leaf multileaf collimators (MLCs). Plans were optimized to achieve the same clinical objectives by applying the same beam energy and the same number and direction of beams. The analysis of performance was based on isodose distributions, dose-volume histograms (DVHs) for planning target volume (PTV), the relevant organs at risk (OARs), as well as mean dose (D-mean), maximum dose (D-max), 95% dose (D-95), volume of patient receiving 2 and 5 Gy, total number of segments, monitor units per segment (MU/Segment), and the number of MU/cGy. Treatment delivery time and conformation number were two other evaluation parameters that were considered in this study. Collectively, the Prowess and KonRad plans showed a significant reduction in the number of MUs that varied between 1.8% and 61.5% (p-value = 0.001) for the different cases, compared to XiO. This was reflected in shorter treatment delivery times. The percentage volumes of each patient receiving 2 Gy and 5 Gy were compared for the three TPSs. The general trend was that KonRad had the highest percentage volume, Prowess showed the lowest (p-value = 0.0001). The KonRad achieved better conformality than both of XiO and Prowess. Based on the present results, the three treatment planning systems were efficient in IMRT, yet XiO showed the lowest performance. The three TPSs achieved the treatment goals according to the internationally approved standards.