Purpose: The aim of this study was to perform a comparison between robust optimization and planning target volume (PTV)-based optimization plans using volumetric modulated arc-therapy (VMAT) by evaluating perturbed doses induced by localization offsets for setup uncertainties in larynx cancer radiation therapy.
Methods: Ten patients with early-stage (T1-2N0) glottis carcinoma were selected. The clinical target volume (CTV), carotid arteries, and spinal cord were contoured by a radiation oncologist. PTV-based and robust optimization plans were normalized at D to the PTV and D to the CTV, respectively. Both optimization plans were evaluated using perturbed doses by specifying user defined shifted values from the isocenter. CTV dose (D, D, and D), homogeneity index (HI) and conformity index (CI, CI, and CI), as well as doses to the carotid arteries and spinal cord were compared between PTV-based and robust optimization plans.
Results: The robust optimization plans exhibited superior CTV coverage and a reduced dose to the carotid arteries compared to the PTV-based optimization plans (p < 0.05). HI, CI and the dose to the spinal cord did not significantly differ between the PTV-based and robust optimization plans (p > 0.05). The robust optimization plans showed better CI and CI compared to the PTV-based optimization plans (p < 0.05). Plan perturbed evaluations showed that the robust optimization plan has small variations in the doses to the CTV, carotid arteries, and spinal cord compared to the PTV-based optimization plan.
Conclusions: The robust optimization plan may be a suitable treatment method in radiotherapy for larynx cancer patient.
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