A bias‐free, automated planning tool for technique comparison in radiotherapy ‐ application to nasopharyngeal carcinoma treatments

In this study a novel, user-independent automated planning technique was developed to objectively compare volumetric modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma planning, and to determine which technique offers a greater benefit for parotid-sparing and dose escalation strategies. Ten patients were investigated, with a standard prescription of three dose levels to the target volumes (70, 63, and 56 Gy), using a simultaneous integrated boost in 33 fractions. The automated tool was used to investigate three planning strategies with both IMRT and VMAT: clinically acceptable plan creation, parotid dose sparing, and dose escalation. Clinically acceptable plans were achieved for all patients using both techniques. For parotid sparing, automated planning reduced the mean dose to a greater extent using VMAT rather than IMRT (17.0 Gy and 19.6 Gy, respectively, p < 0.01). For dose escalation to the mean of the main clinical target volume, neither VMAT nor IMRT offered a significant benefit over the other. The OAR-limiting prescriptions for VMAT ranged from 84-98 Gy, compared to 76-110 Gy for IMRT. Employing a user-independent planning technique, it was possible to objectively compare VMAT and IMRT for nasopharyngeal carcinoma treatment strategies. VMAT offers a parotid-sparing improvement, but no significant benefit was observed for dose escalation to the primary target.