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Purpose <p>Intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) are designed to optimise planning target volume (PTV) coverage while sparing organs at risk (OARs). However, plan selection remains variable due to planner’s experience, patient’s characteristics, and operational constraints.</p> Methods <p>Twenty patients were planned in Monaco 6.1.4. Analysis included dose, volume histogram, monitor units, control points, delivery times, modulation degree and gamma analysis (3%/2mm). Associations between clinico-anatomical factors and optimal technique were assessed using binary logistic regression.</p> Results <p>VMAT improved treatment efficiency (2.18 vs. 5.40 min.), throughput and deliverability (&gt; 96.00%). Single arc (1A) maximised throughput (92 patients/day), while dual arc (2A) achieved superior OARs sparing and conformity in complex anatomy. In IMRT, 5 field (5F) was resource-efficient but QA-limited, and 9 field improved PTV coverage at the cost of time and monitor units (57patients/day). Increasing the fields beyond seven yielded limited benefit. The regression model demonstrated moderate power between physico-clinical factors and irradiation technique (p = 0.009).</p> Conclusions <p>For centers implementing advanced radiotherapy, 1A may serve as an effective starting point due to its balance of efficiency and plan quality. IMRT remains a robust alternative, particularly in resource-constrained settings or where workflow simplicity is prioritised. Personalisation based on anatomy and institutional capacity is essential.</p>

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Implementation-oriented evaluation of IMRT and VMAT configurations for prostate radiotherapy: a decision-support framework for technique selection

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月3日

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  • Florentina Larisa Coc,
  • Loredana G. Marcu

摘要

Purpose

Intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) are designed to optimise planning target volume (PTV) coverage while sparing organs at risk (OARs). However, plan selection remains variable due to planner’s experience, patient’s characteristics, and operational constraints.

Methods

Twenty patients were planned in Monaco 6.1.4. Analysis included dose, volume histogram, monitor units, control points, delivery times, modulation degree and gamma analysis (3%/2mm). Associations between clinico-anatomical factors and optimal technique were assessed using binary logistic regression.

Results

VMAT improved treatment efficiency (2.18 vs. 5.40 min.), throughput and deliverability (> 96.00%). Single arc (1A) maximised throughput (92 patients/day), while dual arc (2A) achieved superior OARs sparing and conformity in complex anatomy. In IMRT, 5 field (5F) was resource-efficient but QA-limited, and 9 field improved PTV coverage at the cost of time and monitor units (57patients/day). Increasing the fields beyond seven yielded limited benefit. The regression model demonstrated moderate power between physico-clinical factors and irradiation technique (p = 0.009).

Conclusions

For centers implementing advanced radiotherapy, 1A may serve as an effective starting point due to its balance of efficiency and plan quality. IMRT remains a robust alternative, particularly in resource-constrained settings or where workflow simplicity is prioritised. Personalisation based on anatomy and institutional capacity is essential.