title: Fully automated treatment planning of spinal metastases - A comparison to manual planning of Volumetric Modulated Arc Therapy for conventionally fractionated irradiation.
abstract: BACKGROUND
  Planning for Volumetric Modulated Arc Therapy (VMAT) may be time consuming and its use is limited by available staff resources. Automated multicriterial treatment planning can eliminate this bottleneck. We compared automatically created (auto) VMAT plans generated by Erasmus-iCycle to manually created VMAT plans for treatment of spinal metastases.
  
  
  METHODS
  Forty-two targets in 32 patients were analyzed. Lungs and kidneys were defined as organs at risk (OARs). Twenty-two patients received radiotherapy on kidney levels, 17 on lung levels, and 3 on both levels.
  
  
  RESULTS
  All Erasmus-iCycle plans were clinically acceptable. When compared to manual plans, planning target volume (PTV) coverage of auto plans was significantly better. The Homogeneity Index did not differ significantly between the groups. Mean dose to OARs was lower in auto plans concerning both kidneys and the left lung. One hotspot (>110% of D50%) occurred in the spinal cord of one auto plan (33.2 Gy, D50%: 30 Gy). Treatment time was 7% longer in auto plans.
  
  
  CONCLUSIONS
  Erasmus-iCycle plans showed better target coverage and sparing of OARs at the expense of minimally longer treatment times (for which no constraint was set).
authors.affiliation: Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. daniel.buergy@umm.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Buergy
authors.affiliation: Department of Radiation Oncology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Abdul Wahab M
authors.initials: AW
authors.lastname: Sharfo
authors.affiliation: Department of Radiation Oncology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Ben J M
authors.initials: BJ
authors.lastname: Heijmen
authors.affiliation: Elekta B.V., De Maas 26, 5684 PL, Best, The Netherlands.
authors.forename: Peter W J
authors.initials: PW
authors.lastname: Voet
authors.affiliation: Department of Radiation Oncology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Breedveld
authors.affiliation: Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Frederik
authors.initials: F
authors.lastname: Wenz
authors.affiliation: Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Lohr
authors.affiliation: Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Stieler
mesh_terms: D001331:Automation; D005500:Follow-Up Studies; D006801:Humans; D009367:Neoplasm Staging; D009369:Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D058958:Organs at Risk / Q000528:radiation effects*; D011379:Prognosis; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D013125:Spinal Neoplasms / Q000532:radiotherapy* / Q000556:secondary
keywords: Automated knowledge-based planning; Erasmus-iCycle; IMRT; VMAT