Abstract
In craniospinal irradiation, field matching is very sensitive to intrafraction positional
uncertainties in cranio-caudal direction, which could lead to severe overdoses/underdoses
inside the planning target volume. During the last decade, significant efforts were
made to develop volumetric-modulated arc therapy strategies, which were less sensitive
to setup uncertainties. In this study, a treatment planning system-integrated method,
named automatic feathering (AF) algorithm, was compared against other volumetric-modulated
arc therapy strategies. Three patients were retrospectively included. Five different
planning techniques were compared, including overlap (O), staggered overlap (SO),
gradient optimization (GO), overlap with AF algorithm turned on (O-AF), and staggered
overlap with AF algorithm turned on (SO-AF). Three overlapping lengths were considered
(5 cm, 7.5 cm, and 10 cm). The middle isocenter was shifted of ±1 mm, ±3 mm, and ±5
mm to simulate setup uncertainties. Plan robustness against simulated uncertainties
was evaluated by calculating near maximum and near minimum dose differences between
shifted and nonshifted plans (ΔD2%, ΔD98%). Dose differences among combinations of techniques and junction lengths were tested
using Wilcoxon signed-rank test. Higher ΔD2% and ΔD98% were obtained using the overlap technique (ΔD2% = 15.4%, ΔD98% = 15.0%). O-AF and SO-AF provided comparable plan robustness to GO technique. Their
performance improved significantly for grater overlapping length. For 10-cm overlap
and 5-mm shift, GO, O-AF, and SO-AF yielded to the better plan robustness (5.7% <
ΔD2% < 6.0%, 6.1% < ΔD98% < 7.6%). SO provided an intermediate plan robustness (9.8% < ΔD2% < 10.8%, 8.9% < ΔD98% < 10.3%). The addition of AF to the overlap technique significantly improves plan
robustness especially if larger overlapping lengths are used. Using the AF algorithm,
plans become as robust as plans optimized with more sophisticated and time-consuming
approaches (like GO).
Keywords
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Article info
Publication history
Published online: September 20, 2020
Accepted:
September 11,
2020
Received in revised form:
July 22,
2020
Received:
April 15,
2020
Identification
Copyright
© 2020 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
