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© 2016. This work is published under http://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Stereotactic radiosurgery (SRS) is the accurate, conformal delivery of high‐dose radiation to well‐defined targets while minimizing normal structure doses via steep dose gradients. While inverse treatment planning (ITP) with computerized optimization algorithms are routine, many aspects of the planning process remain user‐dependent. We performed an international, multi‐institutional benchmark trial to study planning variability and to analyze preferable ITP practice for spinal robotic radiosurgery. 10 SRS treatment plans were generated for a complex‐shaped spinal metastasis with 21 Gy in 3 fractions and tight constraints for spinal cord (V14Gy<2cc, V18Gy<0.1cc) and target (coverage >95%). The resulting plans were rated on a scale from 1 to 4 (excellent‐poor) in five categories (constraint compliance, optimization goals, low‐dose regions, ITP complexity, and clinical acceptability) by a blinded review panel. Additionally, the plans were mathematically rated based on plan indices (critical structure and target doses, conformity, monitor units, normal tissue complication probability, and treatment time) and compared to the human rankings. The treatment plans and the reviewers' rankings varied substantially among the participating centers. The average mean overall rank was 2.4 (1.2‐4.0) and 8/10 plans were rated excellent in at least one category by at least one reviewer. The mathematical rankings agreed with the mean overall human rankings in 9/10 cases pointing toward the possibility for sole mathematical plan quality comparison. The final rankings revealed that a plan with a well‐balanced trade‐off among all planning objectives was preferred for treatment by most participants, reviewers, and the mathematical ranking system. Furthermore, this plan was generated with simple planning techniques. Our multi‐institutional planning study found wide variability in ITP approaches for spinal robotic radiosurgery. The participants', reviewers', and mathematical match on preferable treatment plans and ITP techniques indicate that agreement on treatment planning and plan quality can be reached for spinal robotic radiosurgery.

PACS number(s): 87.55.de

Details

Title
Inverse treatment planning for spinal robotic radiosurgery: an international multi‐institutional benchmark trial
Author
Blanck, Oliver 1 ; Wang, Lei 2 ; Baus, Wolfgang 3 ; Grimm, Jimm 4 ; Lacornerie, Thomas 5 ; Nilsson, Joakim 6 ; Luchkovskyi, Sergii 7 ; Isabel Palazon Cano 8 ; Shou, Zhenyu 9 ; Ayadi, Myriam 10 ; Treuer, Harald 11 ; Viard, Romain 12 ; Frank‐Andre Siebert 13 ; Mark K.H. Chan 14 ; Hildebrandt, Guido 15 ; Dunst, Jürgen 16 ; Imhoff, Detlef 17 ; Wurster, Stefan 6 ; Wolff, Robert 6 ; Romanelli, Pantaleo 18 ; Lartigau, Eric 5 ; Semrau, Robert 3 ; Soltys, Scott G 2 ; Schweikard, Achim 19 

 Department of Radiation Oncology, University Medical Center Schleswig‐Holstein, Kiel, Germany; Department of Radiation Oncology, Saphir Radiosurgery Center, Frankfurt am Main & Güstrow, Germany 
 Department of Radiation Oncology, Stanford University, Stanford, CA, USA 
 Department of Radiation Oncology, University Hospital Cologne, Cologne, Germany 
 Bott Cancer Center, Holy Redeemer Hospital, Meadowbrook, PA, USA 
 Academic Radiation Oncology Department, CLCC Oscar Lambret, & University Lille II, Lille, France 
 Department of Radiation Oncology, Saphir Radiosurgery Center, Frankfurt am Main & Güstrow, Germany 
 Department of Radiation Oncology, CyberClinic Cancer Center Spizhenko, Kyiv, Ukraine 
 Department of Medical Physics, Hospital Ruber Internacional, Madrid, Spain 
 Department of Radiation Oncology, CyberKnife Center Tampa Bay, Tampa Bay, FL, USA 
10  Radiation Therapy Department, Centre Léon Bérard, Lyon, France 
11  Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany 
12  AQUILAB, Loos les Lille, France 
13  Department of Radiation Oncology, University Medical Center Schleswig‐Holstein, Kiel, Germany 
14  Department of Radiation Oncology, Tuen Mun Hospital, Hong Kong, Hong Kong 
15  Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany 
16  Department of Radiation Oncology, University Medical Center Schleswig‐Holstein, Kiel, Germany; Department of Radiation Oncology, University Hospital Copenhagen, Copenhagen, Denmark 
17  Department of Radiation Oncology, Saphir Radiosurgery Center, Frankfurt am Main & Güstrow, Germany; Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany 
18  Brain Radiosurgery & CyberKnife Center, Centro Diagnostico Italiano, Milano, Italy 
19  Institute for Robotic and Cognitive Systems, University of Lübeck, Lübeck, Germany 
Pages
313-330
Section
Radiation Oncology Physics
Publication year
2016
Publication date
May 2016
Publisher
John Wiley & Sons, Inc.
e-ISSN
15269914
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2290081568
Copyright
© 2016. This work is published under http://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.