RESUMEN

PURPOSE: Radiotherapy planning for iliac pelvic nodes can be challenging due to the close proximity of sensitive healthy tissues such as the bowel and rectum. Modern treatment techniques like photon intensity-modulated radiotherapy (IMRT) and intensity-modulated proton therapy (IMPT) offer improved healthy tissue sparing for similar target coverage. In this study we compare IMRT and IMPT plans for six post-cystectomy patients. METHODS: A dose of 50.4 Gy was prescribed to the planning target volume (PTV), which for IMRT is the clinical target volume (CTV) plus a 5 mm expansion for geometric uncertainties due to CTV and patient positioning errors, and for proton beams is the CTV plus the lateral 5 mm margin plus an additional longitudinal margin to allow for the proton range uncertainty. The optimization objectives are: 98% of the PTV receive at least 95% of the prescription, target maximum dose = 107% of prescription, rectum V[40Gy] < 30% and max = 105%, and bowel V[45Gy] < 125 cc and max = 107%. All IMRT and IMPT plans are made to achieve the target coverage objective. RESULTS: Using IMPT, the rectum would receive a mean dose of 9.0 Gy with an average (over the six patients) maximum dose of 38.1 Gy. Using IMRT, the rectum would receive a mean dose of 13.0 Gy and an average maximum dose of 37.6 Gy. The IMPT plans give a mean dose of 17.9 Gy and a maximum dose of 53.4 Gy for the bowel, whereas the IMRT plans give a mean dose of 23.8 Gy and a maximum dose of 53.2 Gy. Both the rectum and bowel show slightly lower mean doses for IMPT. CONCLUSIONS: Our results indicate that IMPT plans improve normal tissue sparing as compared to IMRT plans and provide adequate dose coverage of the target volume.