On the optimal number of dose-limiting shells in the SBRT auto-planning design for peripheral lung cancer.

PURPOSE: The number of dose-limiting shells in the optimization process is one of the key factors determining the quality of stereotactic body radiotherapy (SBRT) auto-planning in the Pinnacle treatment planning system (TPS). This study attempted to derive the optimal number of shells by evaluating the auto-plans designed with different number of shells for peripheral lung cancer patients treated with SBRT. METHODS: Identical treatment technique, optimization process, constraints, and dose calculation algorithm in the Pinnacle TPS were retrospectively applied to 50 peripheral lung cancer patients who underwent SBRT in our center. For each of the patients, auto-plans were optimized based on two shells, three shells, four shells, five shells, six shells, seven shells, eight shells, respectively. The optimal number of shells for the SBRT auto-planning was derived through the evaluations and comparisons of various dosimetric parameters of planning target volume (PTV) and organs at risk (OARs), monitor units (MU), and optimization time of the plans. RESULTS: The conformity index (CI) and the gradient index (GI) of PTV, the maximum dose outside the 2 cm of PTV (D2cm ), Dmax of spinal cord (SCmax ), the percentage of volume of total lung excluding ITV receiving 20 Gy (V20) and 10 Gy (V10), and the mean lung dose (MLD) were improved when the number of shell increased, but the improvement became not significant as the number of shell reached six. The monitor units (MUs) varied little among different plans where no statistical differences were found. However, as the number of shell increased, the auto-plan optimization time increased significantly. CONCLUSIONS: It appears that for peripheral lung SBRT plan using six shells can yield satisfactory plan quality with acceptable beam MUs and optimization time in the Pinnacle TPS.