Planning and Dosimetric Comparisons of IMRT Lung Cancers with Three Advanced Optimization Algorithms

Purpose: To evaluate planning quality and dosimetric differences of clinically deliverable Intensity-modulated Radiation Therapy lung plans generated from Tomotherapy, Pinnacle, and RayStationTM treatment planning systems. Method and Materials: Ten patients diagnosed with non-small-cell lung carcinoma (NSCLC) previously treated with plans on Pinnacle using Direct Machine Parameter Optimization were randomly selected and re-planned with Tomotherapy dose volume constraints and same beam geometry with RayStation Multi Criteria Optimization (MCO) equivalent uniform dose (EUD) or dose volume constraints, respectively. Prescription was established as 60 Gy to cover > 95% of PTV. Planning outcomes such as D95 (95% of volume of PTV receiving the prescribed dose), D5, D33, mean heart and lung doses, V20 (volume of lung receiving 20 Gy), and max cord dose of 1cm were evaluated according to our departmental clinical protocols. Conformity index (CI = PTV/prescription isodose volume) and homogeneity index (HI = D5/D95) were also reported simultaneously. All plans were successfully uploaded for delivery verification. Results: Mean volume of calculated PTV was 356 ± 141 cm. The planning results indicated that CI, HI, D95 and D5 of PTV, V20 of lung, and 1cm max cord dose were comparable but with better overall dosimetric distributions with conformity and homogeneity index from Tomotherapy plans in comparison to both Pinnacle and RayStation planning outcomes. Conclusions: Tomotherapy plans achieved better uniform tumor coverage with fewer hot spots while sparing more critical structures with superior dose fall-off. RayStation plans with MCO automatically generated a set of Pareto optimized solutions with given objectives to allow tradeoffs between targets and critical organs and tended to achieve better tumor coverage compared to Pinnacle. All three planning algorithms can generate clinical deliverable IMRT lung plans while Tomotherapy plans provide superior dosimetric indexes compared to Pinnacle and RayStation due to its unique beamlet optimization process with high modulation.