FIGURE 1.
Comparison of the planning time according to each modality and pathology.
GBM = glioblastoma multiform; IP = Inverse planning; LNR = Lightning® with no consideration of risk structure; LWR: Lightning® with consideration of risk structure; M+OP = Manual planning with optimization; Men = meningioma; Met = metastasis; Pit And = pituitary adenoma; VS = vestibular schwannoma
TABLE 1.
Median results and intervals for the 38 simulation-patients. Median tumor volume was 6.356cc
| General | LNR | LWR | IP | M+OP |
|---|---|---|---|---|
| Time to plan (min:sec) | 00:36.4 (± 00:53.2) | 00:34.1 (± 00:22.9) | 00:50.6 (± 00:20.7) | 01:52.6 (± 00:16.6) |
| Shots | 63 (± 23.3) | 69 (± 33.8) | 27.5 (± 7.5) | 20 (± 7.8) |
| Coverage | 0.99 (± 0.14) | 0.99 (± 0.32) | 0.92 (± 0.43) | 0.91 (± 0.27) |
| Selectivity | 0.78 (± 2.1) | 0.82 (± 0.69) | 0.92 (± 1.93) | 0.90 (± 1.78) |
| Gradient Index | 2.63 (± 0.01) | 2.53 (± 0.05) | 2.88 (± 0.03) | 3.17 (± 0.26) |
| Delivery Time (min) | 46.45 (± 0.68) | 49.3 (± 3.49) | 52.5 (± 11.75) | 47.85 (± 10.04) |
Table 2.
Median of the parameters evaluated with Lightning® (LNR and LWR) and Wizard® (IP and M+OP) and their difference in percentage
| Lightning (LNR and LWR) | Wizard (M+OP and IP) | Difference | |
|---|---|---|---|
| TP (min:sec) | 00:35.3 | 01:21.6 | -57% |
| Shots | 77.5 | 23.75 | 226% |
| Coverage | 0.99 | 0.915 | 8 |
| Selectivity | 0.8 | 0.91 | -12% |
| GI | 2.58 | 3.025 | -15% |
| DT (min) | 47.875 | 50.175 | -5% |
FIGURE 2.
Results of the dose received by the cochlea’s Modiolos in a vestibular schwannoma plan.
IP = Inverse planning; LNR = Lightning® with no consideration of risk structure; LWR = Lightning® with consideration of risk structure; M+OP = Manual planning with optimization
TABLE 3.
Median results and intervals for the patients with separated by pathology and planning techniques
| Coverage | Vestibular schwannoma | Meningioma | Metastasis | Cavities | Pituitary Adenoma | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Meadian Volume (CC) | 1.377 | 6.338 | 6.5595 | 11.4525 | 4.267 | |||||||||||||||
| Planning Technique | LNR | LWR | IP | M+OP | LNR | LWR | IP | M+OP | LNR | LWR | IP | M+OP | LNR | LWR | IP | M+OP | LNR | LWR | IP | M+OP |
| Time to plan (min:sec) | 00:10.9 (± 00:02.2) | 00:09.7 (± 00:00.8) | 00:18.0 (± 00:01.2) | 00:34.8 (± 00:20.9) | 00:36.4 (± 01:31.7) | 01:00.5 (± 01:33.8) | 00:44.4 (± 00:21.9) | 01:49.5 (± 01:51.9) | 00:47.3 (± 00:05.9) | - | 00:44.1 (± 00:02.0) | 02:10.9 (± 02:28.3) | 00:53.7 (± 00:59) | 02:15.7 (± 00:13.8) | 01:14.2 (± 00:13.6) | 02:53.0 (± 01:35.9) | 00:26.1 (± 00:01.3) | 00:42.8 (± 00:00.9) | 00:49.4 (± 00:12.5) | 01:38.4 (± 00:38.0) |
| Shots | 48 (± 10.81) | 42 (± 6.27) | 5 (± 0.46) | 7 (± 3.82) | 74 (± 28.24) | 69 (± 35.39) | 28 (± 4.44) | 18 (± 10.55) | 54.5 (± 2.18) | - | 27 (± 0.24) | 18.5 (± 0.97) | 79.5 (± 29.78) | 112 (± 36.03) | 35.5 (± 2.58) | 31 (± 3.43) | 52 (± 9.53) | 69 (± 9.12) | 28 (± 13.9) | 23 (± 6.44) |
| Coverage | 0.98 (± 0.005) | 0.96 (± 0.004) | 0.88 (± 0.014) | 0.91 (± 0.03) | 0.99 (± 0.002) | 0.99 (± 0.002) | 0.91 (± 0.003) | 0.90 (± 0.006) | 0.99 (± 0.005) | - | 0.91 (± 0.013) | 0.915 (± 0.011) | 0.99 (± 0.009) | 0.99 5 (± 0.007) | 0.915 (± 0.017) | 0.905 (± 0.012) | 0.99 (± 0.0007) | 0.99 (± 0.0031) | 0.92 (± 0.0005) | 0.91 (± 0.0017) |
| Selectivity | 0.86 (± 0.001) | 0.87 (±0.002) | 0.94 (± 0.077) | 0.92 (±1.78) | 0.81 (± 0.01) | 0.83 (± 0.01) | 0.92 (± 0.01) | 0.89 (± 0.01) | 0.74 (± 0.036) | - | 0.90 (± 0.035) | 0.90 (± 0.028) | 0.745 (± 0.09) | 0.785 (± 0.048) | 0.90 (± 0.05) | 0.895 (± 0.03) | 0.775 (± 0.03) | 0.765 (± 0.03) | 0.94 (± 0.01) | 0.93 (± 0.01) |
| Gradient Index | 2.49 (± 0.13) | 2.51 (± 0.18) | 2.61 (± 0.27) | 3.17 (± 0.31) | 2.55 (± 0.14) | 2.505 (± 0.03) | 2.88 (± 0.11) | 3.085 (± 0.43) | 2.77 (± 0.01) | - | 3.01 (± 0.13) | 3.19 (± 0.18) | 2.88 (± 0.29) | 2.58 (± 0.28) | 2.86 (± 0.34) | 3.235 (± 0.63) | 2.58 (± 0.056) | 2.65 (± 0.043) | 2.78 (± 0.199) | 3.12 (± 0.005) |
| Delivery Time (min) | 37.3 (± 4.19) | 49.3 (± 8.87) | 27.8 (± 3.92) | 24 (± 1.22) | 47.3 (± 1.44) | 66.2 (± 0.57) | 47.2 (± 6.77) | 30.9 (± 10.47) | 43.1 (± 7.33) | - | 52.95 (± 0.06) | 56.35 (± 0.61) | 54.4 (± 7.18) | 77.6 (± 21.48) | 75.4 (± 7.66) | 63.8 (± 9.92) | 43.9 (± 17.58) | 49 (± 19.54) | 105.9 (± 0.09) | 55.5 (± 7.75) |
FIGURE 3.
Dose received by optic structures in one (A) and three (B) sessions plans for meningiomas. Dose received by optic structures in one (C) and three (D) sessions plans for pituitary adenomas.
IP = Inverse planning; LWR = Lightning® with consideration of risk structure; LNR = Lightning® with no consideration of risk structure; M+OP = Manual planning with optimization
FIGURE 4.
Scatter plot correlation between time to plan in minutes and tumor volume. (A): Lightning® with no consideration of risk structure (r = 0.84, p < 0.0001); (B): Lightning® with consideration of risk structure (r = 0.45, p = 0.2); (C): Inverse planning (r = 0.74, p < 0.0001); (D): Manual planning with optimization (r = 0.03, p = 0.8).
OAR = organs at risk
FIGURE 5.
Dose-volume histogram (DVH) for clival meningioma (A and B) plan comparing Lightning® with (LWR) and without risk (LNR) structures to a simulation of treatment planning with forward planning with (A) showing tumor results, and (B) showing the organs at risk (OAR) results. Dose-volume histogram for clival meningioma plan (C and D) comparing LWR and LNR to a simulation of treatment planning with forward planning with and without consideration of the OAR. (C) showing tumor results, and (D) showing the OAR results.