Individualized automated planning for dose bath reduction in robotic radiosurgery for benign tumors

PLoS One. 2019 Feb 6;14(2):e0210279. doi: 10.1371/journal.pone.0210279. eCollection 2019.

Abstract

Object: To 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.

Methods: A 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).

Results: With 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).

Conclusion: Automated 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Algorithms*
  • Female
  • Humans
  • Male
  • Neuroma, Acoustic* / diagnostic imaging
  • Neuroma, Acoustic* / surgery
  • Radiosurgery / methods*
  • Radiotherapy Planning, Computer-Assisted*
  • Robotic Surgical Procedures / methods*
  • Tomography, X-Ray Computed*

Grants and funding

This work was in part funded by a research grant of Accuray Inc, Sunnyvale, USA. Erasmus MC Cancer Institute also has research collaboration with Elekta AB Stockholm, Sweden. No additional external funding was received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.