The aim of this study was to experimentally assess the dosimetric impact of leaf interdigitation using different inverse treatment strategies for representative tumour sites and to identify the situations in which leaf interdigitation can benefit these tumour sites.
Sixty previously treated patients (15 nasopharyngeal carcinoma (NPC), 15 multiple brain metastasis (MBM), 15 cervical cancer and 15 prostate cancer) were re-planned for volumetric modulated arc therapy (VMAT), sliding window IMRT (dMLC) and step-and-shoot IMRT (ssIMRT) with and without leaf interdigitation. Various dosimetric variables, such as PTV coverage, OARs sparing, delivery efficiency and planning time, were evaluated for each plan. In addition, a protocol developed by our group was applied to identify the situations in which leaf interdigitation can achieve benefits in clinical practice.
Leaf interdigitation produced few benefits in PTV homogeneity for the MBM VMAT plans and NPC ssIMRT plans. For OARs, sparing was equivalent with and without leaf interdigitation. Leaf interdigitation showed an increase in MUs for dMLC plans and a decrease in MUs for ssIMRT plans. Leaf interdigitation resulted in an increase in segments for dMLC plans and a decrease in segments for NPC and MBM ssIMRT plans. For beam on time, leaf interdigitation showed an increase in MBM dMLC, NPC ssIMRT and prostate ssIMRT plans. In addition, leaf interdigitation saved planning time for VMAT and dMLC plans but increased planning time for ssIMRT plans.
Leaf interdigitation does not improve plan quality when performing inverse treatment strategies, regardless of whether the target is simple or complex. However, it influences the delivery efficiency and planning time. Based on these observations, our study suggests that leaf interdigitation should be utilized when performing MBM VMAT plans and NPC ssIMRT plans.