TU-H-CAMPUS-TeP1-01: Variable-Beam Fractionation for SAbR.

PURPOSE: In current conventionally-fractionated as well as hypofractionated 3D conformal radiotherapy (CRT), the same beam arrangement is employed from fraction to fraction. We challenge this notion and postulate that by varying the beam arrangement between fractions we can achieve greater sparing of organs at risk (OARs) while maintaining PTV coverage. We use an inverse planning strategy using a swarm intelligence-based global optimization algorithm to exploit the additional degree of freedom represented by inter-fractional variation in beam angles.

METHODS: To evaluate our variable-beam fractionation (VBF) method, a 10-beam ITV-based conformal stereotactic ablative radiotherapy (CRT-SAbR) plan was optimized. In the clinical plan, 54 Gy was delivered to a 41cc lung tumor over 3 fractions. In VBF, each original clinically-assigned beam was multiplied to a bundle of n α-degree-spaced beams, n being number of fractions. Selection of α was a compromise between retaining similar tumor irradiation and separating inline OAR sub-regions. We optimized the beam fluence weights setting an upper limit for beam delivery duration (and implicitly, monitor units) along with clinical organ-based dose-volume constraints. Zero weights were allowed so that the optimization algorithm could remove unnecessary beams. All fractions in final plan had to deliver identical monitor units (MU) while satisfying a soft constraint on having no more than one beam from every n-beam bundle in each fraction. α was 10 degrees and the dose rate was 600 MU/min.

RESULTS: The VBF plan achieved significantly superior OAR sparing compared to the clinical internal target volume (ITV)-based plan. Setting maximum beam delivery duration to 13 seconds (well within breath-hold range), Esophagus Dmax, Heart Dmax, Spinal cord Dmax and Lung V13 were improved by 25%, 81%, 0% and 27%, respectively.

CONCLUSION: We investigated a simple approach to inter-fractional VBF planning and demonstrated its potential in reducing dose to OARs. This work was partially supported through research funding from National Institutes of Health (R01CA169102) and Varian Medical Systems, Palo Alto, CA, USA.