Assessment the performances of four commercial treatment planning systems for simultaneous integrated boost IMRT of prostate cancer

Document Type : Original Paper


1 Radiotherapy & Nuclear Medicine Department, Cairo University; Cairo, Egypt

2 Radiotherapy & Nuclear Medicine Department, Cairo University; Cairo, Egypt Fayoum International Hospital, Fayoum, Egypt

3 Department of Biostatistics and epidemiology; National Cancer Institute, Cairo University, Cairo, Egypt


Introduction: This study aims to use the Intensity Modulated Radiation Therapy (IMRT) technique for prostate cancer patients to evaluate the effectiveness of four different commercial Treatment Planning Systems (TPS): (Eclipse, Monaco, Ray plan, and Prowess). In terms of Conformality Index, Homogeneity Index, the dose distributions, the mean dose, the maximum dose, number of segments in each plan for each TPS, Monitor Units per fraction for each treatment plan for each TPS, coverage of the PTVs, and avoidance of Organs At Risk (OARs) for Simultaneous Integrated Boost (SIB) for cancer prostate treatment plans.
Material and Methods: CT images and volumes structure of 10 patients were used to make IMRT plans. The target volume’s structure was contoured according to RTOG 0534 protocol. Fixed beam geometry and clinical goals were set for all individual patient plans. The results were analyzed in terms of dosimetric parameters, the number of segments, and monitor units per segment.
Results: All TPSs achieve similar coverage, and dose distributions to the PTVs. For PTV60 Eclipse achieved the lowest coverage relative to other planning and the nearest mean dose to prescription dose and significant difference relative to other planning. For PTV 44: the Ray plan achieved the best coverage with a significant difference relative to other systems, but Eclipse achieved the nearest mean dose to the prescribed dose with a significant difference relative to the ray plan. Prowess achieved the lowest MU/fraction with a significant difference relative to Monaco the highest in Mus and the lowest possible number of segments.
Conclusion: The four planning systems achieve close dose distributions and confirmation numbers but there is a significant difference in total segments per fraction and total monitor units per fraction which affect the long life of the machine and the session treatment time.


Main Subjects

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA: A Cancer Journal for Clinicians. 2018 Jan 4;68 (1):7-30.
  2. Jayadevappa R, Chhatre S, Wong Y, Wittink M, Cook R, Morales K, et al. Comparative effectiveness of prostate cancer treatments for patient-centered outcomes. Medicine. 2017 May 5;96(18):e6790.
  3. Sierko E, Hempel D, Zuzda K, Wojtukiewicz M. Personalized radiation therapy in cancer pain management. Cancers. 2019 Mar 19;11(3):390.
  4. Hassan IM, Atalla EM, ElGohary MI. Assessment of the second cancer risk after Prostate Cancer Treatment: comparison of 3D conformal radiotherapy and Intensity Modulated Radiotherapy. Iranian Journal of Medical Physics. 2022 Jan 10.
  5. Banaei A, Hashemi B, Bakhshandeh M, Mofid B. The Relationship between the Different Prostate Intensity Modulated Radiation Therapy Techniques and Patient’s Anatomical Parameters. Iranian Journal of Medical Physics. 2018 Dec;15(12):18.
  6. Freedman GM, Anderson PR, Li J, Eisenberg DF, Hanlon AL, Wang L, et al. Intensity Modulated Radiation Therapy (IMRT) Decreases Acute Skin Toxicity for Women Receiving Radiation for Breast Cancer. American Journal of Clinical Oncology 2006 Feb 29(1):66-70.
  7. Parliament MB, Scrimger RA, Anderson SG, Kurien EC, Thompson HK, Field GC, et al. Preservation of oral health-related quality of life and salivary flow rates after inverse-planned intensity-modulated radiotherapy (IMRT) for head-and-neck cancer. International Journal of Radiation Oncology*Biology*Physics. 2004 March;58(3):663-73.
  8. Studer G, Huguenin P, Davis J, Kunz G, Lutolf U, Glanzmann C: IMRT using simultaneously integrated boost (SIB) in head and neck cancer patients. Radiation Oncology. 2006 Mar 31;1(1):7.
  9. Attalla EM, Eldesoky I, Eldebawy E. Simultaneous integrated boost IMRT in pediatric: evaluation for two commercial treatment planning systems. The Chinese-German Journal of Clinical Oncology. 2013 Jan 12;12(1): 6-14.‏
  10. Teh BS, Woo SY, Butler EB. Intensity Modulated Radiation Therapy (IMRT): A New Promising Technology in Radiation Oncology. The Oncologist. 1999 Dec 1;4(6):433-42.
  11. Verhey LJ. Comparison of three-dimensional conformal radiation therapy and intensity-modulated radiation therapy systems. Seminars in Radiation Oncology. 1999 ;9(1):78-98.
  12. Zelefsky MJ, Fuks Z, Hunt M, Yamada Y, Marion C, Ling CC, et al. High-dose intensity-modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients. International Journal of Radiation Oncology*Biology*Physics. 2002 Aug 1;53(5):1111-6.
  13. Ost P, Speleers B, De Meerleer G, De Neve W, Fonteyne V, Villeirs G, et al. Volumetric arc therapy and intensity-modulated radiotherapy for primary prostate radiotherapy with a simultaneous integrated boost to the intraprostatic lesion with 6 and 18 MV: a planning comparison study. International Journal of Radiation Oncology*Biology*Physics. 2011 Mar 1;79(3):920–
  14. Fonteyne V, Villeirs G, Speleers B, De Neve W, De Wagter C, Lumen N, et al. Intensity-Modulated Radiotherapy as Primary Therapy for Prostate Cancer: Report on Acute Toxicity After Dose Escalation with Simultaneous Integrated Boost to Intraprostatic Lesion. International Journal of Radiation Oncology*Biology*Physics. 2008 Nov 1;72(3): 799–
  15. Pinkawa M, Attieh C, Piroth MD, Holy R, Nussen S, Klotz J, et al. Dose-escalation using intensity-modulated radiotherapy for prostate cancer – Evaluation of the dose distribution with and without 18F-choline PET-CT detected simultaneous integrated boost. Radiotherapy and Oncology. 2009 Nov;93(2):213–
  16. Ishii K, Ogino R, Okada W, Nakahara R, Kawamorita R, Nakajima T. A dosimetric comparison of RapidArc and IMRT with a hypofractionated simultaneous integrated boost to the prostate for treatment of prostate cancer. The British Journal of Radiology. 2013 sep 13;86(1030):20130199
  17. Lopez Alfonso J, Parsai S, Joshi N, Godley A, Shah C, Koyfman SA, et al. Temporally feathered intensity‐modulated radiation therapy: A planning technique to reduce normal tissue toxicity. Medical Physics. 2018 May 22;45(7):3466-74.
  18. Uysal B, Beyzadeoğlu M, Sager O, Dinçoğlan F, Demiral S, Gamsız H, et al Dosimetric Evaluation of Intensity Modulated Radiotherapy and 4-Field 3-D Conformal Radiotherapy in Prostate Cancer Treatment. Balkan Medical Journal.2013 Jan 1;30(1):54-7.
  19. Chow JC, Jiang R, Xu L. Dosimetric and radiobiological comparison of prostate VMAT plans optimized using the photon and progressive resolution algorithm. Medical Dosimetry. 2020 Feb 7;45(1), 14-8.‏
  20. Haslam JJ, Bonta DV, Lujan AE, Rash C, Jackson W, Roeske JC. Comparison of the dose calculated by intensity-modulated radiotherapy treatment planning system and an independent monitor unit verification program. Journal of Applied Clinical Medical Physics. 2003 June 1;4(3):224-30.‏
  21. Claus F, Mijnheer B, Rasch C, Bortfeld T, Fraass B, De Gersem W, et al. Report of a Study on IMRT Planning Strategies for Ethmoid Sinus Cancer. Strahlentherapie und Oncology. 2002 oct 178(10):572-6.
  22. Shaw E, Scott C, Souhami L, Dinapoli R, Bahary JP, Kline R, et al. Radiosurgery for the treatment of previously irradiated recurrent primary brain tumors and brain metastases: Initial report of radiation therapy oncology group protocol 90-05. International Journal of Radiation Oncology*Biology*Physics. 1996 Feb 1; 34(3):647-54.
  23. Alber M, Nüsslin F. Optimization of intensity-modulated radiotherapy under constraints for static and dynamic MLC delivery. Physics in medicine and biology. 2001 Nov 14;46(12):3229-39.
  24. Semenenko VA, Reitz B, Day E, Qi XS, Miften M, Li XA. Evaluation of a commercial biologically based IMRT treatment planning system. Medical Physics. 2008 Nov 21;35(12):5851-60.
  25. Eldib A, Zhang D, Abdelgawad MH, Hossain M, Ma C-M. Dosimetric evaluation of the capabilities of two clinical treatment planning systems for prostate cancer. Radiation Physics and Chemistry. 2021 Nov;188:109642.
  26. Fogliata A, Nicolini G, Alber M, Asell M, Dobler B, El-Haddad M, et al. IMRT for breast. A planning study. Radiotherapy and Oncology. 2005 Sep;76(3):300-10.
Volume 20, Issue 1
January and February 2023
Pages 11-18
  • Receive Date: 31 December 2021
  • Revise Date: 21 May 2022
  • Accept Date: 23 May 2022
  • First Publish Date: 23 May 2022