Sci—Sat AM: Stereo — 06: Dosimetric Comparison of 3D Conformai, Flattened and Flattening Filter-Free TrueBeam RapidArc Planning for Lung SBRT



The major advantages of the VMAT SBRT plans compared to the conventional 3D conformai plan include faster delivery and improved target dose conformity. This study quantifies the dosimetric differences among 3D conformai plan; flattened beam and flattening filter-free (FFF) beam RapidArc Plans for lung SBRT. Five early stage lung cancer patients with various tumor positions and sizes previously treated with 3D non-coplanar SBRT were randomly selected. 4DCT was used for each patient to determine the internal target volume. Abdominal compression was applied to minimize respiratory motion for SBRT patients. For treatment planning, a 5 mm margin was given to the ITV to generate a planning target volume. The prescription dose was 48 Gy in 4 fractions and normalized to 95% of the PTV. Organs at risk (OAR) included spinal cord, esophagus, heart, trachea, bilateral lung, and great vessels. Optimization constraints were set to meet the criteria of the RTOG-0915 protocol. All VMAT plans were optimized with the RapidArc technique using two full arcs in Eclipse treatment planning system. The RapidArc SBRT plans with flattened 6MV beam and 6MV FFF beam were generated and dosimetric results were compared with the previous treated 3D non-coplanar plans. RapidArc plans demonstrated better conformity to target, sharper dose fall-off in normal tissues and lower dose to normal lung and other OARs than the 3D conformai plans. RapidArc SBRT for FFF beam showed comparable target conformity, adequate tumor dose, and clinically acceptable DVHs of OARs to flattened beams and significantly reduced treatment delivery time.