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The purpose of this study was to use various dosimetrical indices todetermine the best IMRT modality technique for treating patients with prostatecancer. Ten patients with prostate cancer were included in this study.Intensity modulated radiation therapy plans were designed to include differentmodalities, including the linac step and shoot, Tomotherapy, RapidArc, andProton systems. Various dosimetrical indices, like the prescription isodose totarget volume (PITV) ratio, conformity index (CI), homogeneity index (HI),target coverage index (TCI), modified dose homogeneity index (MHI),conformation number (CN), critical organ scoring index (COSI), and qualityfactor (QF) were determined to compare the different treatment plans.Biological indices such as the generalized equivalent uniform dose (gEUD),based tumor control probability (TCP), and normal tissue complicationprobability (NTCP) were also calculated and used to compare the treatmentplans. The RapidArc plan attained better PTV coverage, as evidenced by itssuperior PITV, CI, TCI, MHI, and CN values. Regarding OARs, proton therapyexhibited superior dose sparing for the rectum and bowel in low dose volumes,whereas the Tomotherapy and RapidArc plans achieved better dose sparing in highdose volumes. The QF scores showed no significant difference among these plans(p=0.701). The average TCPs for prostate tumors in the RapidArc, Linac, andProton plans were higher than the average TCP for Tomotherapy (98.79%, 98.76%,and 98.75% vs. 98.70%, respectively). Regarding the rectum NTCP, RapidArcshowed the most favorable result (0.09%), whereas Linac resulted in the bestbladder NTCP (0.08%).

Treatment plan comparison of Linac step and shoot,Tomotherapy, RapidArc,  and Proton therapy for prostate cancer using dosimetrical and biological  index