Comparison of two optimization algorithms (VOLO(TM), SEQU) for CyberKnife® treatment of acoustic neuromas, lung metastases, and liver metastases

INTRODUCTION: Two optimization algorithms VOLO™ and sequential optimization algorithm (SEQU) are compared in the Precision® treatment planning system from Accuray® for stereotactic radiosurgery and stereotactic body radiotherapy (SBRT) treatment plans. The aim is to compare the two algorithms to assess if VOLO™ is better of SEQU in certain treatment site. MATERIALS AND METHODS: Sixty clinical treatment cases were compared. Entities include Acoustic neuroma (AN), lung metastases, and liver metastases. In each entity, 10 SEQU and 10 VOLO™ treatment plans were optimized. The Ray‐Tracing calculation algorithm was used for all treatment plans and the treatments were planned exclusively with fixed cones (5–50 mm). The number of nodes, beams, total MU, and treatment time were compared. Conformity index (CI), new conformity index (nCI), homogeneity index (HI), gradient index (GI), and target coverage were examined for agreement. D(min), D(mean), D(max), D100%, D98%, and D2% dose in the target volume as well as exposure to organs at risk was checked. To determine peripheral doses, the isodose volumes from V10% to V98% were evaluated. RESULTS: AN treatment plans showed significant differences for the number of nodes, beams, total MU, treatment time, D98%, D100% for the target volume, and the doses for all organs at risk. VOLO™ achieved better results on average. Total MU, treatment time, coverage, and D98% are significantly better for VOLO™ for lung metastases. For liver metastases, a significant reduction in number of nodes, total MU, and treatment time was observed for VOLO™ plans. The mean target coverage increased slightly with VOLO™, while the mean CI deteriorated slightly. The averages of D(min), D(mean), D98%, D100%, and V80% resulted in a significant increase for VOLO™. CONCLUSION: The results of the present study indicate that VOLO™ should be used in place of SEQU as a standard for AN cases moving forward. Despite the lack of significance in the lung and liver cases, VOLO™ optimization is recommended because OAR sparing was similar, but coverage, D(min), and D(mean) were increased, and thus better tumor control can be expected.