SU-E-T-591: Optimizing the Flattening Filter Free Beam Selection in RapidArc-Based Stereotactic Body Radiotherapy for Stage I Lung Cancer




To optimize the flattening filter free (FFF) beam energy selection in stereotactic body radiotherapy (SBRT) treatment for stage I lung cancer with different fraction schemes.


Twelve patients suffering from stage I lung cancer were enrolled in this study. Plans were designed using 6XFFF and 10XFFF beams with the most widely used fraction schemes of 4*12 Gy, 3*18 Gy and 1*34 Gy, respectively. The plan quality was appraised in terms of planning target volume (PTV) coverage, conformity of the prescribed dose (CI100%), intermediate dose spillage (R50% and D2cm), organs at risk (OARs) sparing and beam-on time.


The 10XFFF beam predicted 1% higher maximum, mean dose to the PTV and 4–5% higher R50% compared with the 6XFFF beam in the three fraction schemes, whereas the CI100% and D2cm was similar. Most importantly, the 6XFFF beam exhibited 3–10% lower dose to all the OARs. However, the 10XFFF beam reduced the beam-on time by 31.9±7.2%, 38.7±2.8% and 43.6±4.0% compared with the 6XFFF beam in the 4*12 Gy, 3*18 Gy and 1*34 Gy schemes, respectively. Beam-on time was 2.2±0.2 vs 1.5±0.1, 3.3±0.9 vs 2.0±0.5 and 6.3±0.9 vs 3.5±0.4 minutes for the 6XFFF and 10XFFF one in the three fraction schemes.


The 6XFFF beam obtains better OARs sparing in SBRT treatment for stage I lung cancer, but the 10XFFF one provides improved treatment efficiency. To balance the OARs sparing and intrafractional variation as a function of prolonged treatment time, the authors recommend to use the 6XFFF beam in the 4*12 Gy and 3*18 Gy schemes for better OARs sparing. However, for the 1*34 Gy scheme, the 10XFFF beam is recommended to achieve improved treatment efficiency.