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Life sciences · Journal article
Reports of Practical Oncology & Radiotherapy · September 29, 2026
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Background: Prostate cancer responds well to hypofractionated radiotherapy due to its low α/β ratio. This study compared ultra-hypofractionation (UHF) prostate volumetric modulated arc therapy (VMAT) plans generated by two RapidPlan models incorporating PlanIQ — one trained on multi-fraction (MF) plans and one trained on UHF plans — under a unified UHF prescription and identical optimisation objectives to characterise model-dependent trade-offs. Materials and methods: Two RapidPlan models were developed using libraries of MF plans (2 Gy × 39 fractions) or UHF plans (7.25 Gy × 5 fractions). Both models generated UHF plans (36.25 Gy in 5 fractions) with identical optimisation objectives. Plan quality was evaluated using planning target volume (PTV) D 2% and D 98%, rectum V 18.1 Gy, V 29 Gy, V 36 Gy, and bladder V 18.1 Gy, V 37 Gy. Statistical significance was set at p < 0.05. Comparisons were performed using paired t -tests, with differences interpreted using effect sizes and 95 % confidence intervals. Results: MF-model-based plans achieved better target uniformity (lower PTV D 2% ) with comparable D 98%, whereas UHF-model-based plans provided improved rectal sparing, including a significant reduction in rectal V 36 Gy (p = 0.023). Bladder V 18.1 Gy values were comparable, while MF-model-based plans achieved a small but significant reduction in bladder V 37 Gy (p = 0.029). Differences were generally small, with small-to-moderate effect sizes, indicating consistent but quantitatively modest improvements. Conclusions: The models showed reproducible trade-offs. Multi-fraction training favoured target uniformity and modest bladder sparing, while UHF training favoured rectal dose reduction. These findings support the feasibility of secondary use of MF-trained models for UHF planning within the evaluated workflow. Limitations include a single-institution design and the absence of clinical outcomes; multi-institutional validation is warranted.