SU-E-T-587: Optimal Volumetric Modulated Arc Radiotherapy Treatment Planning Technique for Multiple Brain Metastases with Increasing Number of Arcs

Authors

  • Keeling V,

    1. University of Oklahoma Health Sciences Center, Oklahoma City, OK
    2. University of California San Francisco, San Francisco, CA
    3. University of Toronto, Toronto, ON
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  • Hossain S,

    1. University of Oklahoma Health Sciences Center, Oklahoma City, OK
    2. University of California San Francisco, San Francisco, CA
    3. University of Toronto, Toronto, ON
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  • Hildebrand K,

    1. University of Oklahoma Health Sciences Center, Oklahoma City, OK
    2. University of California San Francisco, San Francisco, CA
    3. University of Toronto, Toronto, ON
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  • Ahmad S,

    1. University of Oklahoma Health Sciences Center, Oklahoma City, OK
    2. University of California San Francisco, San Francisco, CA
    3. University of Toronto, Toronto, ON
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  • Larson D,

    1. University of Oklahoma Health Sciences Center, Oklahoma City, OK
    2. University of California San Francisco, San Francisco, CA
    3. University of Toronto, Toronto, ON
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  • Sahgal A,

    1. University of Oklahoma Health Sciences Center, Oklahoma City, OK
    2. University of California San Francisco, San Francisco, CA
    3. University of Toronto, Toronto, ON
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  • Ma L

    1. University of Oklahoma Health Sciences Center, Oklahoma City, OK
    2. University of California San Francisco, San Francisco, CA
    3. University of Toronto, Toronto, ON
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Abstract

Purpose:

To show improvements in dose conformity and normal brain tissue sparing using an optimal planning technique (OPT) against clinically acceptable planning technique (CAP) in the treatment of multiple brain metastases.

Methods:

A standardized international benchmark case with12 intracranial tumors was planned using two different VMAT optimization methods. Plans were split into four groups with 3, 6, 9, and 12 targets each planned with 3, 5, and 7 arcs using Eclipse TPS. The beam geometries were 1 full coplanar and half non-coplanar arcs. A prescription dose of 20Gy was used for all targets. The following optimization criteria was used (OPT vs. CAP): (No upper limit vs.108% upper limit for target volume), (priority 140–150 vs. 75–85 for normal-brain-tissue), and (selection of automatic sparing Normal-Tissue-Objective (NTO) vs. Manual NTO). Both had priority 50 to critical structures such as brainstem and optic-chiasm, and both had an NTO priority 150. Normal-brain-tissue doses along with Paddick Conformity Index (PCI) were evaluated.

Results:

In all cases PCI was higher for OPT plans. The average PCI (OPT,CAP) for all targets was (0.81,0.64), (0.81,0.63), (0.79,0.57), and (0.72,0.55) for 3, 6, 9, and 12 target plans respectively. The percent decrease in normal brain tissue volume (OPT/CAP*100) achieved by OPT plans was (reported as follows: V4, V8, V12, V16, V20) (184, 343, 350, 294, 371%), (192, 417, 380, 299, 360%), and (235, 390, 299, 281, 502%) for the 3, 5, 7 arc 12 target plans, respectively. The maximum brainstem dose decreased for the OPT plan by 4.93, 4.89, and 5.30 Gy for 3, 5, 7 arc 12 target plans, respectively.

Conclusion:

Substantial increases in PCI, critical structure sparing, and decreases in normal brain tissue dose were achieved by eliminating upper limits from optimization, using automatic sparing of normal tissue function with high priority, and a high priority to normal brain tissue.

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