Multicentre treatment planning inter-comparison in a national context: The liver stereotactic ablative radiotherapy case.
OBJECTIVE
To compare five liver metastasis stereotactic ablative radiotherapy (SABR) plans optimised in fourteen centres with 3D-Conformal-RT, IMRT, VMAT, CyberKnife and Tomotherapy and identify possible dosimetric differences.


METHODS
Dose prescription was 75 Gy in 3 fractions, normalised at 67%-95% isodose.


RESULTS
Excluding few cases, all institutions achieved the planning objectives. Differences up to 40% and 25% in mean dose to liver and PTV were found. No significant correlations between technological factors and DVH for target and OARs were observed; the optimisation strategies selected by the planners played a key role in the planning procedure.


CONCLUSIONS
The human factor and the constraints imposed to the target volume have a greater dosimetric impact than treatment planning and radiation delivery technology in stereotactic treatment of liver metastases. Significant differences found both in terms of dosimetric target coverage and OAR sparing should be taken into consideration before starting a multi-institutional SARB clinical trial.
Azienda Sanitaria Firenze, Italy.
Marco
M
Esposito
Humanitas Clinical and Research Center, Rozzano, Milano, Italy.
Giulia
G
Maggi
Humanitas Catania, Catania, Italy.
Carmelo
C
Marino
Malzoni Radiosurgery Center Salerno, Agropoli, Italy.
Laura
L
Bottalico
Arciospedale S. Maria Nuova, Reggio Emilia, Italy.
Elisabetta
E
Cagni
Niguarda Milano, Italy.
Claudia
C
Carbonini
Azienda Ospedaliera Santa Maria Terni, Terni, Italy.
Michelina
M
Casale
IRCCS CROB, Rionero in Vulture (PZ), Italy.
Stefania
S
Clemente
Malzoni Radiosurgery Center Salerno, Agropoli, Italy.
Valentina
V
D'Alesio
Casa di cura San Rossore Pisa, Pisa, Italy.
David
D
Fedele
A.O.Città della Salute e della scienza di Torino, Italy.
Francesca Romana
FR
Giglioli
National Cancer Institute Regina Elena, Roma, Italy.
Valeria
V
Landoni
CDI Milano, Italy.
Anna
A
Martinotti
ASL Rieti, Italy.
Roberta
R
Nigro
National Cancer Institute Regina Elena, Roma, Italy. Electronic address: strigari@ifo.it.
Lidia
L
Strigari
AUSL Piacenza, Italy.
Elena
E
Villaggi
Humanitas Clinical and Research Center, Rozzano, Milano, Italy.
Pietro
P
Mancosu
D003198:Computer Simulation; D016208:Databases, Factual; D056973:Four-Dimensional Computed Tomography / Q000379:methods; D006801:Humans; D007558:Italy; D008113:Liver Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D009362:Neoplasm Metastasis; D058958:Organs at Risk; D011874:Radiometry / Q000379:methods; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D020266:Radiotherapy, Conformal / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D015203:Reproducibility of Results; D016896:Treatment Outcome
Dosimetry; Liver; Multicentric clinical trial; Stereotactic ablative radiotherapy (SABR); Stereotactic body radiation therapy (SBRT)