Comparison between two treatment planning systems for volumetric modulated arc therapy optimization for prostate cancer

Purpose: To investigate the performances of two commercial treatment planning systems (TPS) for Volumetric Modulated Arc Therapy (VMAT) optimization regarding prostate cancer. The TPS were compared in terms of dose distributions, treatment delivery parameters and quality control results. Materials and methods: For ten patients, two VMAT plans were generated: one with Monaco TPS (Elekta) and one with Pinnacle TPS (Philips Medical Systems). The total prescribed dose was 78 Gy delivered in one 360 degrees arc with a Synergy (R) linear accelerator equipped with a MLCi2 (R). Results: VMAT with Monaco provided better homogeneity and conformity indexes but lower mean dose to PTVs than Pinnacle. For the bladder wall (p = 0.019), the femoral heads (p = 0.017), and healthy tissues (p = 0.005), significantly lower mean doses were found using Monaco. For the rectal wall, VMAT with Pinnacle provided a significantly (p = 0.047) lower mean dose, and lower dose into 50% of the volume (p = 0.047) compared to Monaco. Despite a greater number of monitor units (factor 1.5) for Monaco TPS, the total treatment time was equivalent to that of Pinnacle. The treatment delivery parameter analysis showed larger mean MLC area for Pinnacle and lower mean dose rate compared to Monaco. The quality control results gave a high passing rate (>97.4%) for the gamma index for both TPS but Monaco provided slightly better results. Conclusion: For prostate cancer patients, VMAT treatment plans obtained with Monaco and Pinnacle offered clinically acceptable dose distributions. Further investigations are in progress to confirm the performances of the two TPS for irradiating more complex volumes. (C) 2012 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.