Critical Appraisal of the Treatment Planning Performance of Volumetric Modulated Arc Therapy by Means of a Dual Layer Stacked Multileaf Collimator for Head and Neck, Breast, and Prostate

Purpose: To ascertain whether a new delivery system (the Halcyon system) equipped with dual-layer stacked multileaf collimator operating in a mode, which allows independent, fully interdigitating motion of both layers and 6 flattening filter free energy, could generate plans of high clinical quality compared to a well-established delivery system with single layer multileaf collimator. Methods: Twenty patients in each of the 3 groups (advanced head and neck, breast, and high-risk prostate) were selected for an in silico planning study. For each patient, reference plans were developed for volumetric modulated arc therapy technique with 6 MV photon beams from a TrueBeam linear accelerator and compared against the corresponding plans for the Halcyon system. Plan comparison was performed in terms of dose volume histogram quantitative analysis. Results: Concerning the planning target volumes, with identical dose calculation and optimization algorithms and with identical planning techniques, no clinically relevant difference in coverage (D-98%), hot spot (D-2%), or homogeneity was observed. Similarly, for all the organs at risk, the dosimetric findings showed that (I) all planning constraints were met by the 2 delivery systems and (2) although statistical significant differences were reported for most of the parameters but none of these were judged of potential clinical relevance. Conclusion: The data presented confirmed that the new delivery system can generate treatment plans for volumetric modulated arc therapy with the same dosimetric quality of what is achievable with other systems routinely used in the clinics without significantly changing the current practice. Additional studies which customize the optimization parameters for each delivery device would complement the spectrum of investigations.