On the beam direction search space in computerized non-coplanar beam angle optimization for IMRT-prostate SBRT.

In a recent paper, we have published a new algorithm, designated 'iCycle', for fully automated multi-criterial optimization of beam angles and intensity profiles. In this study, we have used this algorithm to investigate the relationship between plan quality and the extent of the beam direction search space, i.e. the set of candidate beam directions that may be selected for generating an optimal plan. For a group of ten prostate cancer patients, optimal IMRT plans were made for stereotactic body radiation therapy (SBRT), mimicking high dose rate brachytherapy dosimetry. Plans were generated for five different beam direction input sets: a coplanar (CP) set and four non-coplanar (NCP) sets. For CP treatments, the search space consisted of 72 orientations (5° separations). The NCP CyberKnife (CK) space contained all directions available in the robotic CK treatment unit. The fully non-coplanar (F-NCP) set facilitated the highest possible degree of freedom in selecting optimal directions. CK(+) and CK(++) were subsets of F-NCP to investigate some aspects of the CK space. For each input set, plans were generated with up to 30 selected beam directions. Generated plans were clinically acceptable, according to an assessment of our clinicians. Convergence in plan quality occurred only after around 20 included beams. For individual patients, variations in PTV dose delivery between the five generated plans were minimal, as aimed for (average spread in V(95): 0.4%). This allowed plan comparisons based on organ at risk (OAR) doses, with the rectum considered most important. Plans generated with the NCP search spaces had improved OAR sparing compared to the CP search space, especially for the rectum. OAR sparing was best with the F-NCP, with reductions in rectum D(Mean), V(40Gy), V(60Gy) and D(2%) compared to CP of 25%, 35%, 37% and 8%, respectively. Reduced rectum sparing with the CK search space compared to F-NCP could be largely compensated by expanding CK with beams with relatively large direction components along the superior-inferior axis (CK(++)). Addition of posterior beams (CK(++) → F-NCP) did not lead to further improvements in OAR sparing. Plans with 25 beams clearly performed better than 11-beam plans. For CP plans, an increase from 11 to 25 involved beams resulted in reductions in rectum D(Mean), V(40Gy), V(60Gy) and D(2%) of 39%, 57%, 64% and 13%, respectively.