CyberKnife MLC-based treatment planning for abdominal and pelvic SBRT: Analysis of multiple dosimetric parameters, overall scoring index and clinical scoring

Abstract Purpose This study evaluated the plan quality of CyberKnife MLC-based treatment planning in comparison to the Iris collimator for abdominal and pelvic SBRT. Multiple dosimetric parameters were considered together with a global scoring index validated by clinical scoring. Methods and materials Iris and MLC plans were created for 28 liver, 15 pancreas and 13 prostate cases including a wide range of PTV sizes (24–643 cm 3 ). Plans were compared in terms of coverage, conformity (nCI), dose gradient (R50%), homogeneity (HI), OAR doses, PTV gEUD, MU, treatment time both estimated by TPS (t TPS ) and measured. A global plan quality score index was calculated for IRIS and MLC solutions and validated by a clinical score given independently by two observers. Results Compared to Iris, MLC achieved equivalent coverage and conformity without compromising OAR sparing and improving R50% (p  TPS (−22%). Time reduction was partially lost when measured. The global score index was significantly higher for MLC solutions which were selected in 73% and 64% of cases respectively by the first and second observer. Conclusion Iris and MLC comparison was not straightforward when based on multiple dosimetric parameters. The use of a mathematical overall score index integrated with a clinical scoring was essential to confirm MLC plans advantages over Iris solutions.