A comparison of inverse optimization algorithms for HDR/PDR prostate brachytherapy treatment planning

Purpose Graphical optimization (GrO) is a common method for high-dose-rate/pulsed-dose-rate (PDR) prostate brachytherapy treatment planning. New methods performing inverse optimization of the dose distribution have been developed over the past years. The purpose is to compare GrO and two established inverse methods, inverse planning simulated annealing (IPSA) and hybrid inverse treatment planning and optimization (HIPO), and one new method, enhanced geometric optimization–interactive inverse planning (EGO–IIP), in terms of speed and dose–volume histogram (DVH) parameters. Methods and Materials For 26 prostate cancer patients treated with a PDR brachytherapy boost, an experienced treatment planner optimized the dose distributions using four different methods: GrO, IPSA, HIPO, and EGO–IIP. Relevant DVH parameters (prostate—V100%, D90%, V150%; urethra—D0.1cm3 and D1.0cm3; rectum—D0.1cm3 and D2.0cm3; bladder—D2.0cm3) were evaluated and their compliance to the constraints. Treatment planning time was also recorded. Results All inverse methods resulted in shorter planning time (mean, 4–6.7 min), as compared with GrO (mean, 7.6 min). In terms of DVH parameters, none of the inverse methods outperformed the others. However, all inverse methods improved on compliance to the planning constraints as compared with GrO. On average, EGO–IIP and GrO resulted in highest D90%, and the IPSA plans resulted in lowest bladder D2.0cm3 and urethra D1.0cm3. Conclusions Inverse planning methods decrease planning time as compared with GrO for PDR/high-dose-rate prostate brachytherapy. DVH parameters are comparable for all methods.