Dosimetric impact of Acuros XB dose-to-water and dose-to-medium reporting modes on VMAT planning for head and neck cancer

Purpose: To assess the dosimetric impact of switching from the Analytical Anisotropic Algorithm (AAA) to Acuros XB (AXB) for both dose-to-medium (Dm) and dose-to-water (Dw) in VMAT for H&N patients. To study whether it should be linked to a change in the dose prescriptions to the PTVs and in the constraints to the OARs.

Methods: 110H&N patients treated with VMAT were included. Calculations were performed with AAA and AXB. PTV54, PTV60, PTV70, spinal cord, brainstem, brain, larynx, oral cavity, cochleas, parotid glands and mandible were delineated. Clinically-relevant dose-volume parameters were compared. Paired t-tests were used to analyze the differences in mean values. The Pitman-Morgan dispersion test was computed to evaluate inter-patient variability of these differences.

Results: AAA overestimated all dose-volume parameters compared to AXB Dm (0.2 Gy to 2.4 Gy). No systematic trend was observed in the differences between AAA and AXB Dw (-5.3 Gy to 0.6 Gy). Dose-volume parameters were significantly higher for AXB Dw compared to AXB Dm (0.1 Gy to 6.6 Gy). In all cases, the largest absolute differences (4%-14%) were found for maximum absorbed doses to the cochleas and the mandible. The number of parameters with significant inter-patient variability was greater when switching from AAA to AXB Dw than from AAA to AXB Dm.

Conclusions: There are important differences between AXB and AAA in VMAT planning for H&N cancer. The systematic differences and their inter-patient variability identified may help to facilitate decision-making about the dose prescriptions to the PTVs and the constraints to the OAR.