Abstract Purpose To develop a fully automated procedure for multicriterial volumetric modulated arc therapy (VMAT) treatment planning (autoVMAT) for stage III/IV non-small cell lung cancer (NSCLC) patients treated with curative intent. Materialsandmethods After configuringthe developedautoVMAT system for NSCLC, autoVMAT plans were compared with manually generated clinically delivered intensity-modulated radiotherapy (IMRT) plans for 41 patients. AutoVMAT plans were also compared to manually generated VMAT plans in the absence of time pressure. For 16patientswithreducedplanningtargetvolume(PTV)dose prescription in the clinical IMRT plan (to avoid violation of organs at risk tolerances), the potential for dose escalation with autoVMAT was explored. Results Two physicians evaluated 35/41 autoVMAT plans (85%) as clinically acceptable. Compared to the manually generated IMRT plans, autoVMAT plans showed statistically significant improved PTV coverage (V95%increased by 1.1% ± 1.1%), higher dose conformity (R50 reduced by 12.2% ± 12.7%), and reduced mean lung, heart, and esophagus doses (reductions of 0.9Gy ± 1.0Gy, 1.5Gy ± 1.8Gy, 3.6Gy ± 2.8Gy, respectively, all p < 0.001). To render During part of the work Steven Petit was also affiliated to Massachusetts General Hospital—Harvard Medical School  Maarten L. P. Dirkx, Ph.D. m.dirkx@erasmusmc.nl 1 Department of Radiation Oncology, Erasmus MC Cancer Institute, 5201, 3008 AE Rotterdam, The Netherlands 2 Scuola di Scienze, Alma Mater Studiorum, Università di Bologna, Bologna, Italy 3 Department of Radiation Oncology, Massachusetts General Hospital—Harvard Medical School, Boston, MA, USA the six remaining autoVMAT plans clinically acceptable, a dosimetrist needed less than 10min hands-on time for fine-tuning. AutoVMAT plans were also considered equivalent or better than manually optimized VMAT plans. For 6/16 patients, autoVMAT allowed tumor dose escalation of 5–10Gy. Conclusion Clinically deliverable, high-quality autoVMAT plans can be generated fully automatically for the vast majority of advanced-stage NSCLC patients. For a subset of patients, autoVMAT allowed for tumor dose escalation.
Keywords Radiotherapy, intensity-modulated · Volumetric-modulated arc therapy · Computer-assisted radiotherapy planning · Non-small cell lung carcinoma · Organs at risk