Radiotherapy treatment planning for prostate and nodes using variable planning ring

Background: Prostate cancer is one of the most common solid malignancies and has a high morbidity rate. The uncertainty of the prostate location compromises the overall treatment plan optimisation. To account for the location uncertainty, the radiation oncologist needs to expand the margin of the planning target volume (PTV), which may increase the radiation toxicity to organs in proximity. Materials and methods: In this study, we investigated the quality of treatment plans for a patient with different ring sizes (2 and 3 cm). A small ring-shaped structure circumferentially around the PTV helps in defining the location of PTV. Prostate and pelvic node plans were analysed with dose prescription to 99% of PTV. Results: Additional ring-shaped structures led to more conformal dose coverage for target with reduced radiation side effects to nearby organ at risk (OAR). Expected treatment time was slightly higher for 2 cm ring compared to 3 cm ring. In case of prostate, expected duration was 4% higher, while for node plan, expected duration for 2 cm ring was 16% higher compared to 3 cm ring plan. Conclusions: It was observed that using a smaller size ring can lead to improved dose sparing to OAR with same target coverage as with larger dimension ring. The composite plans do not show any clinically significant difference in dose to OARs.