Improved organ sparing using auto-planned Stanford volumetric modulated arc therapy for total body irradiation...

To evaluate dosimetric differences between auto-planned volumetric modulated arc therapy (VMAT) total body irradiation (TBI) technique and two-dimensional radiotherapy using anterior-posterial/posterio-anterial beams (2D AP/PA) TBI technique.

Ten pediatric patients treated with VMAT-TBI on Varian c-arm linac were included in this study. VMAT-TBI plans were generated using our in-house developed and publicly shared auto-planning scripts. For each VMAT-TBI plan, a 2D AP/PA plan was created replicating the institution's clinical setup with the patient positioned at extended source to skin distance (SSD) with a compensator to account for differences in patient thickness, 50% transmission daily lung blocks, and electron chest wall boosts prescribed to 50% of the photon prescription. Clinically relevant metrics were analyzed and compared between the VMAT and 2D plans.

All VMAT-TBI plans achieved planned target volume (PTV) D90% ≥ 100% of prescription. VMAT-TBI PTV D90% significantly increased (7.1% ± 2.9%, p < .001) compared to the 2D technique, whereas no differences were observed in global D_max (p < .2) and PTV V110% (p < .4). Compared to the 2D plans, significant decreases in the D_mean to the lungs (-25.6% ± 11.5%, p < .001) and lungs-1 cm (-34.1% ± 10.1%, p < .001) were observed with the VMAT plans. The VMAT technique also enabled decrease of dose to other organs: kidneys D_mean (-32.5% ± 5.0%, p < .001) and lenses D_max (-5.3% ± 8.1%, p = .03); and in addition, for 2 Gy prescription: testes/ovaries D_mean (-41.5% ± 11.5%, p < .001), brain D_mean (-22.6% ± 5.4%, p = .002), and thyroid D_mean (-18.2% ± 16.0%, p = .03).

Superior lung sparing with improved target coverage and similar global D_max were observed with the VMAT plans as compared to 2D plans. In addition, VMAT-TBI plans provided greater dose reductions in gonads, kidneys, brain, thyroid, and lenses.