{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T21:59:36Z","timestamp":1791410376640,"version":"4.3.3"},"reference-count":23,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T00:00:00Z","timestamp":1611187200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Recently, VOLO\u2122 was introduced as a new optimizer for CyberKnife<jats:bold>\u00ae<\/jats:bold> planning. In this study, we investigated possibilities to improve treatment plans for MLC\u2010based prostate SBRT with enhanced peripheral zone dose while sparing the urethra, and central lung tumors, compared to existing Sequential Optimization (SO). The primary focus was on reducing OAR doses. For 25 prostate and 25 lung patients treated with SO plans, replanning with VOLO\u2122 was performed with the same planning constraints. For equal PTV coverage, almost all OAR plan parameters were improved with VOLO\u2122. For prostate patients, mean rectum and bladder doses were reduced by 34.2% (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) and 23.5% (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), with reductions in D<jats:sub>0.03cc<\/jats:sub> of 3.9%, 11.0% and 3.1% for rectum, mucosa and bladder (all <jats:italic>P<\/jats:italic>\u00a0\u2264\u00a00.01). Urethra D<jats:sub>5%<\/jats:sub> and D<jats:sub>10%<\/jats:sub> were 3.8% and 3.0% lower (<jats:italic>P<\/jats:italic>\u00a0\u2264\u00a00.002). For lung patients, esophagus, main bronchus, trachea, and spinal cord D<jats:sub>0.03cc<\/jats:sub> was reduced by 18.9%, 11.1%, 16.1%, and 13.2%, respectively (all <jats:italic>P<\/jats:italic>\u00a0\u2264\u00a00.01). Apart from the dosimetric advantages of VOLO\u2122 planning, average reductions in MU, numbers of beams and nodes for prostate\/lung were 48.7\/32.8%, 26.5\/7.9% and 13.4\/7.9%, respectively (<jats:italic>P<\/jats:italic>\u00a0\u2264\u00a00.003). VOLO\u2122 also resulted in reduced delivery times with mean\/max reductions of: 27\/43% (prostate) and 15\/41% (lung), <jats:italic>P<\/jats:italic>\u00a0 &lt;\u00a00.001. Planning times reduced from 6\u00a0h to 1.1\u00a0h and from 3\u00a0h to 1.7\u00a0h for prostate and lung, respectively. The new VOLO\u2122 planning was highly superior to SO planning in terms of dosimetric plan quality, and planning and delivery times.<\/jats:p>","DOI":"10.1002\/acm2.13172","type":"journal-article","created":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T18:11:16Z","timestamp":1611252676000},"page":"35-47","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Largely reduced OAR doses, and planning and delivery times for challenging robotic SBRT cases, obtained with a novel optimizer"],"prefix":"10.1002","volume":"22","author":[{"given":"Marta K.","family":"Gi\u017cy\u0144ska","sequence":"first","affiliation":[{"name":"Erasmus MC Cancer Institute University Medical Center Rotterdam Department of Radiotherapy Dr.Molewaterplein 40 Rotterdam 3015 GD The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Rossi","sequence":"additional","affiliation":[{"name":"Erasmus MC Cancer Institute University Medical Center Rotterdam Department of Radiotherapy Dr.Molewaterplein 40 Rotterdam 3015 GD The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilhelm","family":"den Toom","sequence":"additional","affiliation":[{"name":"Erasmus MC Cancer Institute University Medical Center Rotterdam Department of Radiotherapy Dr.Molewaterplein 40 Rotterdam 3015 GD The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maaike T. W.","family":"Milder","sequence":"additional","affiliation":[{"name":"Erasmus MC Cancer Institute University Medical Center Rotterdam Department of Radiotherapy Dr.Molewaterplein 40 Rotterdam 3015 GD The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim C.","family":"de Vries","sequence":"additional","affiliation":[{"name":"Erasmus MC Cancer Institute University Medical Center Rotterdam Department of Radiotherapy Dr.Molewaterplein 40 Rotterdam 3015 GD The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joost","family":"Nuyttens","sequence":"additional","affiliation":[{"name":"Erasmus MC Cancer Institute University Medical Center Rotterdam Department of Radiotherapy Dr.Molewaterplein 40 Rotterdam 3015 GD The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben J. M.","family":"Heijmen","sequence":"additional","affiliation":[{"name":"Erasmus MC Cancer Institute University Medical Center Rotterdam Department of Radiotherapy Dr.Molewaterplein 40 Rotterdam 3015 GD The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,21]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"1","article-title":"Clinical impact of the VOLO optimizer on treatment plan quality and clinical treatment efficiency for CyberKnife","author":"Sch\u00fcler E","year":"2020","journal-title":"J Appl Clin Med Phys"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2019.07.020"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2020.02.009"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/end.2009.0438"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-717X-8-84"},{"key":"e_1_2_9_7_1","first-page":"15","article-title":"A Technical Overview of the CyberKnife System. 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