SU‐E‐T‐435: Flattening Filter Free Beams for Head and Neck IMRT and VMAT Optimization

Abstract

Purpose:To investigate if there is benefits of using flattening filter free (FFF) versus flattening filter (FF) beams during plan optimization for head and neck targets.Methods:Five head and neck cancer patients previously treated were selected for this study. Each plan was optimized for volumetric modulated arc therapy (VMAT) using 2 full arcs. Target volumes and the organs at risk (OAR) were outlined by the same physician. The prescription doses for each patient and the dose limits for each OAR were specified by the physician. For each patient four plans were created by varying the photon beam energy (6MV vs 10MV) and the use of FF or FFF. For each patient the prescription dose and OAR dose limits remained unchanged. Furthermore, the number of optimization iterations remained the same for each plan without user interference. The plans were compared using dose volume histograms, conformity and homogeneity indices.Results:Our results showed that the plans optimized with FF beams produced more homogeneous dose distributions in the PTV than the ones with FFF beams (0.92 vs. 0.86 and 0.92 vs.85 for 6MVFF, 6MVFFF, 10MVFF and 10MVFFF respectively). The conformity was better for FFF beams than for FF beams (1.26 vs. 1.20 and 1.27 vs. 1.21 for 6MVFF, 6MVFFF, 10MVFF and 10MVFFF respectively). The overall minimum, maximum and means doses were reduced for the FFF plans by approximately 4% to 6%. All FFF plans allowed more sparing of organs at risk by 7% to 9% on average. Only one 10MVFFF plan had a 1% higher dose than the respective 10MVFF for the spinal cord.Conclusion:The 6MVFFF and 10MVFFF beams illustrated the improvement of normal tissue sparing while achieving similar target dose distribution compared to 6MVFF and 10MVFF beams. Further investigation is required to determine the magnitude of improvement. case specific, fluence‐based optimization improved both PTV and OAR dosimetry in 80% of cases.