Automated non-coplanar beam direction optimization improves IMRT in SBRT of liver metastasis

Purpose: To investigate whether automatically optimized coplanar, or non-coplanar beam setups improve intensity modulated radiotherapy (IMRT) treatment plans for stereotactic body radiotherapy (SBRT) of liver tumors, compared to a reference equi-angular IMRT plan. Methods: For a group of 13 liver patients, an in-house developed beam selection algorithm (Cycle) was used for generation of 3D-CRT plans with either optimized coplanar-, or non-coplanar beam setups. These 10 field, coplanar and non-coplanar setups, and an 11 field, equi-angular coplanar reference setup were then used as input for generation of IMRT plans. For all plans, the PTV dose was maximized in an iterative procedure by increasing the prescribed PTV dose in small steps until further increase was prevented by constraint violation(s). Results: For optimized non-coplanar setups, D-PTV,D- (max) increased by on average 30% (range 8-64%) compared to the corresponding reference IMRT plan. Similar increases were observed for D-PTV, 99% and gEUD(a). For optimized coplanar setups, mean PTV dose increases were only similar to 4%. After re-scaling all plans to the clinically applied dose, optimized non-coplanar configurations resulted in the best sparing of organs at risk (healthy liver, spinal cord, bowel). Conclusion: Compared to an equi-angular beam setup, computer optimized non-coplanar setups do result in substantial improvements in IMIRT plans for SBRT of liver tumors. (C) 2008 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 88 (2008) 376-381.