Largely reduced OAR doses, and planning and delivery times for challenging robotic SBRT cases, obtained with a novel optimizer

Marta K. Giżyńska; Linda Rossi; Wilhelm den Toom; Maaike T.W. Milder; Kim C. de Vries; Joost Nuyttens; Ben J.M. Heijmen

doi:10.1002/acm2.13172

Largely reduced OAR doses, and planning and delivery times for challenging robotic SBRT cases, obtained with a novel optimizer

Marta K. Giżyńska^*, Linda Rossi, Wilhelm den Toom, Maaike T.W. Milder, Kim C. de Vries, Joost Nuyttens, Ben J.M. Heijmen

^*Corresponding author for this work

Radiotherapy

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Recently, VOLO™ was introduced as a new optimizer for CyberKnife® planning. In this study, we investigated possibilities to improve treatment plans for MLC-based prostate SBRT with enhanced peripheral zone dose while sparing the urethra, and central lung tumors, compared to existing Sequential Optimization (SO). The primary focus was on reducing OAR doses. For 25 prostate and 25 lung patients treated with SO plans, replanning with VOLO™ was performed with the same planning constraints. For equal PTV coverage, almost all OAR plan parameters were improved with VOLO™. For prostate patients, mean rectum and bladder doses were reduced by 34.2% (P < 0.001) and 23.5% (P < 0.001), with reductions in D_0.03cc of 3.9%, 11.0% and 3.1% for rectum, mucosa and bladder (all P ≤ 0.01). Urethra D_5% and D_10% were 3.8% and 3.0% lower (P ≤ 0.002). For lung patients, esophagus, main bronchus, trachea, and spinal cord D_0.03cc was reduced by 18.9%, 11.1%, 16.1%, and 13.2%, respectively (all P ≤ 0.01). Apart from the dosimetric advantages of VOLO™ planning, average reductions in MU, numbers of beams and nodes for prostate/lung were 48.7/32.8%, 26.5/7.9% and 13.4/7.9%, respectively (P ≤ 0.003). VOLO™ also resulted in reduced delivery times with mean/max reductions of: 27/43% (prostate) and 15/41% (lung), P < 0.001. Planning times reduced from 6 h to 1.1 h and from 3 h to 1.7 h for prostate and lung, respectively. The new VOLO™ planning was highly superior to SO planning in terms of dosimetric plan quality, and planning and delivery times.

Original language	English
Pages (from-to)	35-47
Number of pages	13
Journal	Journal of Applied Clinical Medical Physics
Volume	22
Issue number	3
Early online date	21 Jan 2021
DOIs	https://doi.org/10.1002/acm2.13172
Publication status	Published - Mar 2021

Bibliographical note

Funding Information:
This work was in part funded by a research grant of Accuray Inc. Erasmus MC Cancer Institute also has research collaborations with Elekta AB Stockholm, Sweden. No additional external funding was received for this study. The funders had no role in study design, data collection and analysis, and decisions on preparation of the manuscript and publication.

Publisher Copyright:
© 2021 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

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Largely reduced OAR doses, and planning and delivery times for challenging robotic SBRT cases, obtained with a novel optimizerFinal published version, 1.54 MBLicence: CC BY

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Giżyńska, M. K., Rossi, L., den Toom, W., Milder, M. T. W., de Vries, K. C., Nuyttens, J., & Heijmen, B. J. M. (2021). Largely reduced OAR doses, and planning and delivery times for challenging robotic SBRT cases, obtained with a novel optimizer. Journal of Applied Clinical Medical Physics, 22(3), 35-47. Advance online publication. https://doi.org/10.1002/acm2.13172

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title = "Largely reduced OAR doses, and planning and delivery times for challenging robotic SBRT cases, obtained with a novel optimizer",

abstract = "Recently, VOLO{\texttrademark} was introduced as a new optimizer for CyberKnife{\textregistered} planning. In this study, we investigated possibilities to improve treatment plans for MLC-based prostate SBRT with enhanced peripheral zone dose while sparing the urethra, and central lung tumors, compared to existing Sequential Optimization (SO). The primary focus was on reducing OAR doses. For 25 prostate and 25 lung patients treated with SO plans, replanning with VOLO{\texttrademark} was performed with the same planning constraints. For equal PTV coverage, almost all OAR plan parameters were improved with VOLO{\texttrademark}. For prostate patients, mean rectum and bladder doses were reduced by 34.2% (P < 0.001) and 23.5% (P < 0.001), with reductions in D0.03cc of 3.9%, 11.0% and 3.1% for rectum, mucosa and bladder (all P ≤ 0.01). Urethra D5% and D10% were 3.8% and 3.0% lower (P ≤ 0.002). For lung patients, esophagus, main bronchus, trachea, and spinal cord D0.03cc was reduced by 18.9%, 11.1%, 16.1%, and 13.2%, respectively (all P ≤ 0.01). Apart from the dosimetric advantages of VOLO{\texttrademark} planning, average reductions in MU, numbers of beams and nodes for prostate/lung were 48.7/32.8%, 26.5/7.9% and 13.4/7.9%, respectively (P ≤ 0.003). VOLO{\texttrademark} also resulted in reduced delivery times with mean/max reductions of: 27/43% (prostate) and 15/41% (lung), P < 0.001. Planning times reduced from 6 h to 1.1 h and from 3 h to 1.7 h for prostate and lung, respectively. The new VOLO{\texttrademark} planning was highly superior to SO planning in terms of dosimetric plan quality, and planning and delivery times.",

author = "Gi{\.z}y{\'n}ska, {Marta K.} and Linda Rossi and {den Toom}, Wilhelm and Milder, {Maaike T.W.} and {de Vries}, {Kim C.} and Joost Nuyttens and Heijmen, {Ben J.M.}",

note = "Funding Information: This work was in part funded by a research grant of Accuray Inc. Erasmus MC Cancer Institute also has research collaborations with Elekta AB Stockholm, Sweden. No additional external funding was received for this study. The funders had no role in study design, data collection and analysis, and decisions on preparation of the manuscript and publication. Publisher Copyright: {\textcopyright} 2021 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.",

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AU - Giżyńska, Marta K.

AU - Rossi, Linda

AU - den Toom, Wilhelm

AU - Milder, Maaike T.W.

AU - de Vries, Kim C.

AU - Nuyttens, Joost

AU - Heijmen, Ben J.M.

N1 - Funding Information: This work was in part funded by a research grant of Accuray Inc. Erasmus MC Cancer Institute also has research collaborations with Elekta AB Stockholm, Sweden. No additional external funding was received for this study. The funders had no role in study design, data collection and analysis, and decisions on preparation of the manuscript and publication. Publisher Copyright: © 2021 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

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N2 - Recently, VOLO™ was introduced as a new optimizer for CyberKnife® planning. In this study, we investigated possibilities to improve treatment plans for MLC-based prostate SBRT with enhanced peripheral zone dose while sparing the urethra, and central lung tumors, compared to existing Sequential Optimization (SO). The primary focus was on reducing OAR doses. For 25 prostate and 25 lung patients treated with SO plans, replanning with VOLO™ was performed with the same planning constraints. For equal PTV coverage, almost all OAR plan parameters were improved with VOLO™. For prostate patients, mean rectum and bladder doses were reduced by 34.2% (P < 0.001) and 23.5% (P < 0.001), with reductions in D0.03cc of 3.9%, 11.0% and 3.1% for rectum, mucosa and bladder (all P ≤ 0.01). Urethra D5% and D10% were 3.8% and 3.0% lower (P ≤ 0.002). For lung patients, esophagus, main bronchus, trachea, and spinal cord D0.03cc was reduced by 18.9%, 11.1%, 16.1%, and 13.2%, respectively (all P ≤ 0.01). Apart from the dosimetric advantages of VOLO™ planning, average reductions in MU, numbers of beams and nodes for prostate/lung were 48.7/32.8%, 26.5/7.9% and 13.4/7.9%, respectively (P ≤ 0.003). VOLO™ also resulted in reduced delivery times with mean/max reductions of: 27/43% (prostate) and 15/41% (lung), P < 0.001. Planning times reduced from 6 h to 1.1 h and from 3 h to 1.7 h for prostate and lung, respectively. The new VOLO™ planning was highly superior to SO planning in terms of dosimetric plan quality, and planning and delivery times.

AB - Recently, VOLO™ was introduced as a new optimizer for CyberKnife® planning. In this study, we investigated possibilities to improve treatment plans for MLC-based prostate SBRT with enhanced peripheral zone dose while sparing the urethra, and central lung tumors, compared to existing Sequential Optimization (SO). The primary focus was on reducing OAR doses. For 25 prostate and 25 lung patients treated with SO plans, replanning with VOLO™ was performed with the same planning constraints. For equal PTV coverage, almost all OAR plan parameters were improved with VOLO™. For prostate patients, mean rectum and bladder doses were reduced by 34.2% (P < 0.001) and 23.5% (P < 0.001), with reductions in D0.03cc of 3.9%, 11.0% and 3.1% for rectum, mucosa and bladder (all P ≤ 0.01). Urethra D5% and D10% were 3.8% and 3.0% lower (P ≤ 0.002). For lung patients, esophagus, main bronchus, trachea, and spinal cord D0.03cc was reduced by 18.9%, 11.1%, 16.1%, and 13.2%, respectively (all P ≤ 0.01). Apart from the dosimetric advantages of VOLO™ planning, average reductions in MU, numbers of beams and nodes for prostate/lung were 48.7/32.8%, 26.5/7.9% and 13.4/7.9%, respectively (P ≤ 0.003). VOLO™ also resulted in reduced delivery times with mean/max reductions of: 27/43% (prostate) and 15/41% (lung), P < 0.001. Planning times reduced from 6 h to 1.1 h and from 3 h to 1.7 h for prostate and lung, respectively. The new VOLO™ planning was highly superior to SO planning in terms of dosimetric plan quality, and planning and delivery times.

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Largely reduced OAR doses, and planning and delivery times for challenging robotic SBRT cases, obtained with a novel optimizer

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