Transition From Manual to Automated Planning and Delivery of Volumetric Modulated Arc Therapy Stereotactic Radiosurgery: Clinical, Dosimetric, and Quality Assurance Results

PurposeProperly planned single isocenter volumetric modulated arc therapy (VMAT) radiosurgery plans exhibit high quality and efficiency. We report here the largest clinical experience to date, our knowledge, comparing manual planning with a new automated platform designed standardize simplify delivery processes.MethodsWe treated 693 patients VMAT radiosurgical generated by either conventional (mVMAT) or recently implemented (HyperArcTM) technique. All targeted gross tumor volume without margin. Radiochromic film was used for patient-specific assurance (PSQA). evaluated local control toxicity data subgroup of 107 having 377 metastatic tumors that were HyperArc.ResultsThe median Radiation Therapy Oncology Group (RTOG) conformity index 1.14 not different between 2 techniques. The Paddick gradient 5.42 HyperArc versus 7.09 mVMAT (P < .001). mean brain doses 4.6% 5.1% mVMAT, respectively = .04). PSQA both techniques met criteria, but 97% satisfied gamma tolerance limit recommended American Association Physicists in Medicine Task No. 218, compared 94% .02). treatment-planning times significantly different. treatment 10.5 11.4 minutes Kaplan-Meier estimate 90.1% at 1 year.ConclusionsHyperArc produces high-quality are least as good created an expert planner easier more efficient workflow. A less experienced can produce very even than 10 targets. use single-isocenter technique multiple targets no PTV margin did compromise outcomes, 1-year remained congruent historical series.