Dosimetric Comparison of Different Dose Calculation Algorithms in Postmastectomy Breast Cancer Patients Using Conformal Planning Techniques

Background: The aim of the current study was to compare three different dose-calculating algorithms, i.e., superposition (SP), fast SP (FSP), and convolution (CV), for breast cancer patients treated with intensity-modulated radiotherapy (IMRT) and field-in-Field forward plan IMRT (FiF-FP-IMRT). Materials and Methods: The current retrospective study involved 100 postmastectomy breast cancer patients who were given radiotherapy using IMRT and FiF-FP-IMRT planning techniques. All the initially SP-calculated plans were recalculated with the same monitor units for FSP and CV algorithm without change in any of the other planning parameters. The isodose distribution and various plan evaluating parameters, for example, conformity index (CI), homogeneity index, and uniformity index target volume and normal structure doses were compared and analyzed for all the different algorithm calculated plans. Results: In the IMRT plans, all the target and normal structure dose-volume parameters showed a significant difference between all the three different algorithms with P < 0.05. In the FiF-FP-IMRT plans, CV algorithm showed a significant difference in most of the target and normal structure dose-volume parameters. Among quality indexes, only CI showed a significant difference between all the algorithms in both the planning techniques. R-50 showed a significant difference with the CV algorithm in both the planning techniques. Conclusion: The change in the dose calculation algorithm resulted in dosimetric changes which must be evaluated by the medical physicists and oncologists while evaluating treatment plans. In the current study with breast patients, the results obtained for target and normal structure doses using the CV algorithm are overestimated as compared to SP and FSP algorithms, producing variable results in air and bony normal structures. However, the ipsilateral lung V-5 parameter and the ipsilateral humeral head mean dose were found to be underestimated by the CV algorithm as compared to the SP and FSP algorithm in both the planning techniques.