SU-E-T-437: Four-Dimensional Treatment Planning for Lung VMAT-SBRT

Purpose: To assess optimal treatment planning approach of Volumetric Modulated Arc Therapy for lung Stereotactic Body Radiation Therapy (VMAT-SBRT). Methods: Subjects were 10 patients with lung cancer who had undergone 4DCT. The internal target volume (ITV) volume ranged from 2.6 to 16.5cm3 and the tumor motion ranged from 0 to 2cm. From 4DCT, which was binned into 10 respiratory phases, 4 image data sets were created; maximum intensity projection (MIP), average intensity projection (AIP), AIP with the ITV replaced by 0HU (RITV-AIP) and RITV-AIP with the planning target volume (PTV) minus the internal target volume was set to −200 HU (HR-AIP). VMAT-SBRT plans were generated on each image set for a patient. 48Gy was prescribed to 95% of PTV. The plans were recalculated on all phase images of 4DCT and the dose distributions were accumulated using a deformable image registration software MIM Maestro™ as the 4D calculated dose to the gross tumor volume (GTV). The planned dose to the ITV and 4D calculated dose to the GTV were compared. Results: In AIP plan, 10 patients average of all dose parameters (D1%, D_mean, and D99%) discrepancy were 1Gy or smaller. MIP and RITV-AIP plans resulted in having common tendency and larger discrepancy than AIP plan. The 4D dose was lower than the planned dose, and 10 patients average of all dose parameters discrepancy were in range 1.3 to 2.6Gy. HR-AIP plan had the largest discrepancy in our trials. 4D calculated D1%, D_mean, and D99% were resulted in 3.0, 4.1, and 6.1Gy lower than the expected in plan, respectively. Conclusion: For all patients, the dose parameters expected in AIP plan approximated to 4D calculated. Using AIP image set seems optimal treatment planning approach of VMAT-SBRT for a mobile tumor. Funding Support: This work was supported by the Japan Society for the Promotion of Science Core-to-Core program (No. 23003).