The application of dynamic field shaping and dynamic dose rate control in conformal rotational treatment of the prostate

The current philosophy of dose escalation in the treatment of prostate cancer has forced the treatment planner to re-evaluate his/her planning approach. Precise and accurate delivery of dose to the prostate while maintaining the required dose limits to the normal critical structures, such as the rectum, has become increasingly difficult in light of these escalated doses. Conformal treatment techniques allow the treatment planner to precisely shape each individual treatment field so that desired volume coverage and normal tissue sparing can be achieved. In addition to these beam-shaping advantages, adjustment of an individual beam's weighting also helps to create the desired distribution and tissue sparing. Rotational therapy 'simulates' treatment with multiple beams and angles, similar to the thought process behind conformal treatment technique. With rotational therapy, however, the treatment planner's inability to provide adequate beam shaping and weighting adjustment has placed limits on its value as a viable planning option. The introduction of computer-controlled treatment machines, which allow dynamic adjustment of the field shape with the rotation of the beam, makes it possible to re-evaluate rotational therapy as a potential option. Similarly, the treatment planner's ability to change field weighting can be accomplished by the application of dynamic dose rate control, allowing a rotational beam to deliver a weighting similar to that possible with conformal fixed-field techniques. Dose-volume histogram data will be used to evaluate doses delivered to the prostate, rectum, and bladder using rotational therapy with dynamic field shape and dynamic dose rate control as a treatment planning option. The dose delivery and normal tissue-sparing potential of this technique compared to coplanar and noncoplanar conformal fixed-field techniques will also be presented