Automated treatment planning for liver cancer stereotactic body radiotherapy

Purpose To evaluate the quality of fully automated stereotactic body radiation therapy (SBRT) planning based on volumetric modulated arc therapy, which can reduce the reliance on historical plans and the experience of dosimetrists. Methods Fully automated re-planning was performed on twenty liver cancer patients, automated plans based on automated SBRT planning (ASP) program and manual plans were conducted and compared. One patient was randomly selected and evaluate the repeatability of ASP, ten automated and ten manual SBRT plans were generated based on the same initial optimization objectives. Then, ten SBRT plans were generated for another selected randomly patient with different initial optimization objectives to assess the reproducibility. All plans were clinically evaluated in a double-blinded manner by five experienced radiation oncologists. Results Fully automated plans provided similar planning target volume dose coverage and statistically better organ at risk sparing compared to the manual plans. Notably, automated plans achieved significant dose reduction in spinal cord, stomach, kidney, duodenum, and colon, with a median dose of D 2% reduction ranging from 0.64 to 2.85 Gy. R50% and D mean of ten rings for automated plans were significantly lower than those of manual plans. The average planning time for automated and manual plans was 59.8 ± 7.9 min vs. 127.1 ± 16.8 min (− 67.3 min). Conclusion Automated planning for SBRT, without relying on historical data, can generate comparable or even better plan quality for liver cancer compared with manual planning, along with better reproducibility, and less clinically planning time.