Dosimetric comparison of pencil beam scanning proton therapy with or without multi-leaf collimator versus volumetric-modulated arc therapy for treatment of malignant glioma

This study aimed to examine the dosimetric effect of intensity-modulated proton therapy (IMPT) with a multi-leaf collimator (MLC) in treating malignant glioma. We compared the dose distribution of IMPT with or without MLC (IMPTMLC + or IMPTMLC-, respectively) using pencil beam scanning and volumetric -modulated arc therapy (VMAT) in simultaneous integrated boost (SIB) plans for 16 patients with malig-nant gliomas. High-and low-risk target volumes were assessed using D 2% , V 90% , V 95% , homogeneity index (HI), and conformity index (CI). Organs at risk (OARs) were evaluated using the average dose (Dmean) and D 2% . Furthermore, the dose to the normal brain was evaluated using from V5Gy to V40Gy at 5 Gy intervals. There were no significant differences among all techniques regarding V 90% , V 95% , and CI for the targets. HI and D 2% for IMPTMLC + and IMPTMLC-were significantly superior to those for VMAT ( p < 0.01). The Dmean and D 2% of all OARs for IMPTMLC + were equivalent or superior to those of other techniques. Regarding the normal brain, there was no significant difference in V40Gy among all techniques whereas V5Gy to V35Gy in IMPTMLC + were significantly smaller than those in IMPTMLC-(with differences ranging from 0.45% to 4.80%, p < 0.05) and VMAT (with differences ranging from 6.85% to 57.94%, p < 0.01). IMPTMLC + could reduce the dose to OARs, while maintaining target coverage compared to IMPTMLC-and VMAT in treating malignant glioma.(c) 2023 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.