Abstract
ObjectTo explore the use of automated planning in robotic radiosurgery of benign vestibular schwannoma (VS) tumors for dose reduction outside the planning target volume (PTV) to potentially reduce risk of secondary tumor induction.MethodsA system for automated planning (AUTOplans) for VS patients was set up. The goal of AUTO- planning was to reduce the dose bath, including the occurrence of high dose spikes leaking from the PTV into normal tissues, without worsening PTV coverage, OAR doses, or treatment time. For 20 VS patients treated with 1x12 Gy, the AUTOplan was compared with the plan generated with conventional, manual trial-and-error planning (MANplan).ResultsWith equal PTV coverage, AUTOplans showed clinically negligible differences with MANplans in OAR sparing (largest mean difference for all OARs: ΔD2% = 0.2 Gy). AUTOplan dose distributions were more compact: mean/maximum reductions of 23.6/53.8% and 9.6/28.5% in patient volumes receiving more than 1 or 6 Gy, respectively (p<0.001). AUTOplans also showed smaller dose spikes with mean/maximum reductions of 22.8/37.2% and 14.2/40.4% in D2% for shells at 1 and 7 cm distance from the PTV, respectively (p<0.001).ConclusionAutomated planning for benign VS tumors highly outperformed manual planning with respect to the dose bath outside the PTV, without deteriorating PTV coverage or OAR sparing, or significantly increasing treatment time.
Highlights
Stereotactic radiosurgery is an increasingly used option for management of patients with benign vestibular schwannoma (VS) tumors [1,2,3,4,5]
AUTOplans showed smaller dose spikes with mean/maximum reductions of 22.8/37.2% and 14.2/ 40.4% in D2% for shells at 1 and 7 cm distance from the planning target volume (PTV), respectively (p
Treatment plans in radiotherapy are generally generated in an interactive trialand-error process in which the planner tries to steer the treatment planning system (TPS) towards generation of an acceptable solution (“manual planning”)
Summary
Stereotactic radiosurgery is an increasingly used option for management of patients with benign vestibular schwannoma (VS) tumors [1,2,3,4,5]. Treatment plans in radiotherapy are generally generated in an interactive trialand-error process in which the planner tries to steer the treatment planning system (TPS) towards generation of an acceptable solution (“manual planning”). This may be a time consuming process and the resulting plan quality may heavily depend on the skills and experience of the planner and on the available planning time and software. The potential of automated treatment planning for both enhancement of plan quality and drastic reduction in planning time, as alternative to manual planning, has been shown in many studies [14,15,16,17,18,19,20,21,22,23]
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