Integral Dose and Dosimetric Comparison of 3D-CRT, IMRT and VMAT Radiotherapy Techniques for Prostate Cancer

Document Type : Original Paper

Authors

1 University of Health Sciences Istanbul Training and Research Hospital, Department of Radiation Oncology-İstanbul, Turkey

2 University of Health Sciences Istanbul Training and Research Hospital, Department of Radiation Oncology, Science Private Health Services Medical Physicist

10.22038/ijmp.2025.89332.2575

Abstract

Introduction: This study aimed to compare the treatment planning volumes and the integral doses (ID) during radiotherapy for prostate cancer using three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT) techniques.
Material and Methods: The study included 10 patients treated in our clinic, diagnosed with intermediate risk prostate cancer at the T2bN0M0 stage, Gleason score ≤ 7 and prostate-specific antigen (PSA) levels between 10-20 ng/mL. For each patient, 6 MV photon energy was used for 3D-CRT, IMRT and VMAT planning.
Results: The rectum, bladder, right and left femur, body IDs, the homogeneity index (HI), and conformity index (CI) values were found to be higher in 3D-CRT planning compared to IMRT and VMAT planning (p < 0.001). The body mean, and ID were lower in VMAT planning compared to IMRT and 3D-CRT plans (p < 0.001). The monitor unit (MU) value was significantly higher in the IMRT planning compared to VMAT and 3D-CRT plans, and higher in the VMAT plan compared to 3D-CRT plans (p < 0.001).
Conclusion: According to our study, for organ protection, body ID doses and HI, as well as CI, the VMAT planning technique is mostly superior to IMRT and 3D-CRT. In terms of MU, the 3D-CRT planning technique is better than the others. Our findings indicate that VMAT could generate plans that deliver lower IDs to healthy tissues while providing relatively uniform doses to the target area; and lower MUs.

Keywords

Main Subjects

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49.
  2. Darko J, Osei E, Fleck A, Ramana Rachakonda. Retrospective dosimetric evaluation of VMAT plans for prostate cancer treatment. Journal of Radiotherapy in Practise. 2019;18(2):155-64.
  3. Elith C, Dempsey SE, Findlay N, Warren-Forward HM. An Introduction to the Intensity-modulated Radiation Therapy (IMRT) Techniques, Tomotherapy, and VMAT. J Med Imaging Radiat Sci. 2011;42(1):37-43.
  4. Palma D, Vollans E, James K, Nakano S, Moiseenko V, Shaffer R, et al. Volumetric modulated arc therapy for delivery of prostate radiotherapy: comparison with intensity-modulated radiotherapy and three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72(4):996-1001.
  5. Aoyama H, Westerly DC, Mackie TR, Olivera GH, Bentzen SM, Patel RR, et al. Integral radiation dose to normal structures with conformal external beam radiation. Int J Radiat Oncol Biol Phys 2006;64(3):962-7.
  6. Hall EJ. Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys 2006;65(1):1-7.
  7. Feuvret L, Noël G, Mazeron JJ, Bey P. Conformity index: a review. Int J Radiat Oncol Biol Phys. 2006;64(2):333-42.
  8. Hodapp N. ICRU Report 83 Prescribing, Recording, and Reporting Photon-Beam Intensity-Modulated Radiation Therapy (IMRT). Strahlenther Onkol 2012;188(1):97-9.
  9. Numakura K, Kobayashi M, Muto Y, Sato H, Sekine Y, Sobu R, et al. The current trend of radiation therapy for patients with localized prostate cancer. Curr Oncol. 2023;30(9):8092-110.
  10. Amaloo C, Nazareth DP, Kumaraswamy LK. Comparison of hybrid volumetric modulated arc therapy (VMAT) technique and double arc VMAT technique in the treatment of prostate cancer. Radiol Oncol. 2015;49(3):291-8.
  11. Kyei KA, Daniels J, Adom AK, Odonkor P, Nyantakyi AY, Adjabu DE. A dosimetric evaluation of intensity modulated radiotherapy and three-dimensional conformal radiotherapy for prostate cancer in Ghana. Ecancermedicalscience. 2024;18:1707.
  12. Jani AB, Su A, Correa D, Gratzle J. Comparison of late gastrointestinal and genitourinary toxicity of prostate cancer patients undergoing intensity-modulated versus conventional radiotherapy using localized fields. Prostate Cancer Prostatic Dis. 2007;10(1):82-6.
  13. Michalski JM, Yan Y, Watkins-Bruner D, Bosch WR, Winter K, Galvin JM, et al. Preliminary toxicity analysis of 3-dimensional conformal radiation therapy versus intensity modulated radiation therapy on the high-dose arm of the Radiation Therapy Oncology Group 0126 prostate cancer trial. Int J Radiat Oncol Biol Phys. 2013;87(5):932-8.
  14. Viani G, Hamamura AC, Faustino AC. Intensity modulated radiotherapy (IMRT) or conformational radiotherapy (3D-CRT) with conventional fractionation for prostate cancer: Is there any clinical difference?. Int Braz J Urol. 2019;45(6):1105-12.
  15. Shi C, Peñagarícano J, Papanikolaou N. Comparison of IMRT treatment plans between linac and helical tomotherapy based on integral dose and inhomogeneity index. Med Dosim. 2008;33(3):215-21.
  16. Ślosarek K, Osewski W, Grządziel A, Radwan M, Dolla Ł, Szlag M, et al. Integral dose: Comparison between four techniques for prostate radiotherapy. Rep Pract Oncol Radiother. 2014;20(2):99-103.
  17. Samir F, Meaz TM, Hussiny FA, Ahmed AA, Mahmoud AA, Refaat T, et al. Analytical dosimetric study of intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) for prostate cancer. J Cancer Res Clin Oncol. 2023;149(9):6239-46.
  18. Cakir A, Akgun Z, Fayda M, Agaoglu F. Comparison of three dimensional conformal radiation therapy, intensity modulated radiation therapy and volumetric modulated arc therapy for low radiation exposure of normal tissue in patients with prostate cancer. Asian Pac J Cancer Prev. 2015;16(8):3365-70.
  19. Mukhtar R, Butt S, Rafaye MA, Iqbal K, et al. An institutional review: dosimetry comparison between simultaneous integrated boost IMRT and VMAT for prostate cancer. Journal of Radiotherapy in Practice. 2021;20(3):321-31.
  20. Fischer-Valuck BW, Rao YJ, Michalski JM. Intensity-modulated radiotherapy for prostate cancer. Transl Androl Urol. 2018;7(3):297-307.
  21. Ekici K, Kuloğlu M, Ata ÖA, Atahan O, Tiryakioğlu O. A Dosimetric Comparison of 7 Field IMRT, 9 Field IMRT, VMAT and 3-D Conformal Radiotherapy for the Treatment of Localized Intermediate Risk of Prostate Cancer. International Journal of Hematology and Oncology. 2022;32(3):133-40.

 

Iranian Journal of Medical Physics
Volume 22, Issue 6 - Serial Number 6
November and December 2025
Pages 405-410

Files

History

  • Receive Date: 09 July 2025
  • Revise Date: 21 September 2025
  • Accept Date: 25 November 2025

Share

How to cite

Statistics