{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T21:28:58Z","timestamp":1789421338321,"version":"build-2803163510"},"reference-count":42,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T00:00:00Z","timestamp":1702944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>This study aimed to comprehensively present data on treatment optimization in linac-based SBRT for localized prostate cancer at a single institution. Moreover, the dosimetric quality and treatment efficiency of single-arc (SA) versus dual-arc (DA) VMAT planning and delivery approaches were compared. Re-optimization was performed on twenty low-to-intermediate-risk- (36.25 Gy in 5 fractions) and twenty high-risk (42.7 Gy in 7 fractions) prostate plans initially administered with the DA FFF-VMAT technique in 2021. An SA approach was adopted, incorporating new optimization parameters based on increased planning and clinical experience. Analysis included target coverage, organ-at-risk (OAR) sparing, treatment delivery time, and the pre-treatment verification\u2019s gamma analysis-passing ratio. The SA optimization technique has consistently produced superior plans. Rectum and bladder mean doses were significantly reduced, and comparable target coverage and homogeneity were achieved in order to maintain a urethra protection strategy. The mean SA treatment delivery time was reduced by 22%; the mean monitor units increased due to higher plan complexity; and dose measurements demonstrated optimal agreement with calculations. The substantial reduction in treatment delivery time decreased the probability of prostate motion beyond the applied margins, suggesting potential decrease in treatment-related toxicity and improved target coverage in prostate SBRT. Further investigations are warranted to assess the long-term clinical outcomes.<\/jats:p>","DOI":"10.3390\/cancers16010013","type":"journal-article","created":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T11:17:24Z","timestamp":1702984644000},"page":"13","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Treatment Optimization in Linac-Based SBRT for Localized Prostate Cancer: A Single-Arc versus Dual-Arc Plan Comparison"],"prefix":"10.3390","volume":"16","author":[{"given":"Denis","family":"Panizza","sequence":"first","affiliation":[{"name":"Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"},{"name":"School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Faccenda","sequence":"additional","affiliation":[{"name":"Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3880-8876","authenticated-orcid":false,"given":"Stefano","family":"Arcangeli","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy"},{"name":"Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"De Ponti","sequence":"additional","affiliation":[{"name":"Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy"},{"name":"School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.critrevonc.2011.11.009","article-title":"Will SBRT replace conventional radiotherapy in patients with low-intermediate risk prostate cancer? A review","volume":"84","author":"Arcangeli","year":"2012","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.prro.2018.08.002","article-title":"Hypofractionated Radiation Therapy for Localized Prostate Cancer: Executive Summary of an ASTRO, ASCO, and AUA Evidence-Based Guideline","volume":"8","author":"Morgan","year":"2018","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.ijrobp.2020.01.010","article-title":"Diminishing Returns from Ultrahypofractionated Radiation Therapy for Prostate Cancer","volume":"107","author":"Vogelius","year":"2020","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.radonc.2013.08.030","article-title":"Stereotactic body radiotherapy for localized prostate cancer: Pooled analysis from a multi-institutional consortium of prospective phase II trials","volume":"109","author":"King","year":"2013","journal-title":"Radiother. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"240","DOI":"10.3389\/fonc.2014.00240","article-title":"Stereotactic body radiotherapy as treatment for organ confined low- and intermediate-risk prostate carcinoma, a 7-year study","volume":"4","author":"Katz","year":"2014","journal-title":"Front. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.radonc.2018.03.005","article-title":"Dose escalation for prostate stereotactic ablative radiotherapy (SABR): Late outcomes from two prospective clinical trials","volume":"127","author":"Alayed","year":"2018","journal-title":"Radiother. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e188006","DOI":"10.1001\/jamanetworkopen.2018.8006","article-title":"Long-term Outcomes of Stereotactic Body Radiotherapy for Low-Risk and Intermediate-Risk Prostate Cancer","volume":"2","author":"Kishan","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/j.ijrobp.2019.03.051","article-title":"Stereotactic Body Radiation Therapy for Localized Prostate Cancer: A Systematic Review and Meta-Analysis of Over 6000 Patients Treated on Prospective Studies","volume":"104","author":"Jackson","year":"2019","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/S0140-6736(19)31131-6","article-title":"Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial","volume":"394","author":"Widmark","year":"2019","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/S1470-2045(20)30581-7","article-title":"Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer (HYPO-RT-PC): Patient-reported quality-of-life outcomes of a randomised, controlled, non-inferiority, phase 3 trial","volume":"22","author":"Fransson","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1016\/S1470-2045(19)30569-8","article-title":"Intensity-modulated fractionated radiotherapy versus stereotactic body radiotherapy for prostate cancer (PACE-B): Acute toxicity findings from an international, randomised, open-label, phase 3, non-inferiority trial","volume":"20","author":"Brand","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1016\/S1470-2045(22)00517-4","article-title":"Intensity-modulated radiotherapy versus stereotactic body radiotherapy for prostate cancer (PACE-B): 2-year toxicity results from an open-label, randomised, phase 3, non-inferiority trial","volume":"23","author":"Tree","year":"2022","journal-title":"Lancet Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1001\/jamaoncol.2022.6558","article-title":"Magnetic Resonance Imaging-Guided vs Computed Tomography-Guided Stereotactic Body Radiotherapy for Prostate Cancer: The MIRAGE Randomized Clinical Trial","volume":"9","author":"Kishan","year":"2023","journal-title":"JAMA Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/S0360-3016(01)01453-5","article-title":"Organ motion and its management","volume":"50","author":"Langen","year":"2001","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.radonc.2010.01.010","article-title":"Intra-fraction prostate displacement in radiotherapy estimated from pre- and post-treatment imaging of patients with implanted fiducial markers","volume":"95","author":"Kron","year":"2010","journal-title":"Radiother. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1088\/0031-9155\/60\/2\/549","article-title":"Intra-fraction motion of the prostate is a random walk","volume":"60","author":"Ballhausen","year":"2015","journal-title":"Phys. Med. Biol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1002\/acm2.12195","article-title":"Real-time intrafraction prostate motion during linac based stereotactic radiotherapy with rectal displacement","volume":"18","author":"Legge","year":"2017","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e388","DOI":"10.1016\/j.prro.2020.04.013","article-title":"Prostate SBRT With Intrafraction Motion Management Using a Novel Linear Accelerator-Based MV-kV Imaging Method","volume":"10","author":"Gorovets","year":"2020","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"883725","DOI":"10.3389\/fonc.2022.883725","article-title":"Intrafraction Prostate Motion Management During Dose-Escalated Linac-Based Stereotactic Body Radiation Therapy","volume":"12","author":"Panizza","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.ijrobp.2007.10.049","article-title":"Dosimetric consequences of intrafraction prostate motion","volume":"71","author":"Li","year":"2008","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"7073","DOI":"10.1088\/0031-9155\/53\/24\/005","article-title":"Correlation between dosimetric effect and intrafraction motion during prostate treatments delivered with helical tomotherapy","volume":"53","author":"Langen","year":"2008","journal-title":"Phys. Med. Biol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.ijrobp.2010.02.033","article-title":"Dosimetric effect of intrafraction motion and residual setup error for hypofractionated prostate intensity-modulated radiotherapy with online cone beam computed tomography image guidance","volume":"80","author":"Adamson","year":"2011","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1016\/j.ijrobp.2013.12.045","article-title":"Intrafraction prostate translations and rotations during hypofractionated robotic radiation surgery: Dosimetric impact of correction strategies and margins","volume":"88","author":"Valli","year":"2014","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1016\/j.ijrobp.2013.12.015","article-title":"Assessing the dosimetric impact of real-time prostate motion during volumetric modulated arc therapy","volume":"88","author":"Azcona","year":"2014","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.ejmp.2020.06.010","article-title":"Dosimetric effect of intrafraction motion and different localization strategies in prostate SBRT","volume":"75","author":"Vanhanen","year":"2020","journal-title":"Phys. Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Faccenda, V., Panizza, D., Daniotti, M.C., Pellegrini, R., Trivellato, S., Caricato, P., Lucchini, R., De Ponti, E., and Arcangeli, S. (2023). Dosimetric Impact of Intrafraction Prostate Motion and Interfraction Anatomical Changes in Dose-Escalated Linac-Based SBRT. Cancers, 15.","DOI":"10.3390\/cancers15041153"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"20220852","DOI":"10.1259\/bjr.20220852","article-title":"Prostate stereotactic body radiotherapy: Quantifying intra-fraction motion and calculating margins using the new BIR geometric uncertainties in daily online IGRT recommendations","volume":"96","author":"McNeice","year":"2023","journal-title":"Br. J. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.phro.2018.05.001","article-title":"The effect of prostate motion during hypofractionated radiotherapy can be reduced by using flattening filter free beams","volume":"6","author":"Benedek","year":"2018","journal-title":"Phys. Imaging Radiat. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.ijrobp.2018.12.045","article-title":"Five-Year Outcomes of a Phase 1 Dose-Escalation Study Using Stereotactic Body Radiosurgery for Patients With Low-Risk and Intermediate-Risk Prostate Cancer","volume":"104","author":"Zelefsky","year":"2019","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/j.ijrobp.2022.12.022","article-title":"Five-Year Patient-Reported Outcomes in NRG Oncology RTOG 0938, Evaluating Two Ultrahypofractionated Regimens for Prostate Cancer","volume":"116","author":"Lukka","year":"2023","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.ijrobp.2013.10.042","article-title":"Impact of dose to the bladder trigone on long-term urinary function after high-dose intensity modulated radiation therapy for localized prostate cancer","volume":"88","author":"Ghadjar","year":"2014","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.radonc.2016.04.005","article-title":"Normal tissue complication probability (NTCP) models for late rectal bleeding, stool frequency and fecal incontinence after radiotherapy in prostate cancer patients","volume":"119","author":"Schaake","year":"2016","journal-title":"Radiother. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Neilsen, B.K., Ma, T.M., Akingbemi, W.O., Neylon, J., Casado, M., Sharma, S., Sheng, K., Ruan, D., Low, D.A., and Yang, Y. (2023). Impact of Interfractional Bladder and Trigone Displacement and Deformation on Radiation Exposure and Subsequent Acute Genitourinary Toxicity: A Post-Hoc Analysis of Patients Treated with MRI-guided Prostate Stereotactic Body Radiotherapy in a Phase III Randomized Trial. Int. J. Radiat. Oncol. Biol. Phys.","DOI":"10.1016\/j.ijrobp.2023.10.015"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1515\/raon-2017-0005","article-title":"Optimal planning strategy among various arc arrangements for prostate stereotactic body radiotherapy with volumetric modulated arc therapy technique","volume":"51","author":"Kang","year":"2017","journal-title":"Radiol. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ijrobp.2021.06.037","article-title":"Radiation Dose to the Intraprostatic Urethra Correlates Strongly with Urinary Toxicity After Prostate Stereotactic Body Radiation Therapy: A Combined Analysis of 23 Prospective Clinical Trials","volume":"112","author":"Leeman","year":"2022","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3287","DOI":"10.1007\/s00345-023-04579-6","article-title":"State of the art and future challenges of urethra-sparing stereotactic body radiotherapy for prostate cancer: A systematic review of literature","volume":"41","author":"Bosetti","year":"2023","journal-title":"World J. Urol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.radonc.2009.08.015","article-title":"Is a single arc sufficient in volumetric-modulated arc therapy (VMAT) for complex-shaped target volumes?","volume":"93","author":"Guckenberger","year":"2009","journal-title":"Radiother. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1093\/jrr\/rraa123","article-title":"Dosimetric comparison between volumetric modulated arc therapy planning techniques for prostate cancer in the presence of intrafractional organ deformation","volume":"62","author":"Varnava","year":"2021","journal-title":"J. Radiat. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/j.1754-9485.2011.02324.x","article-title":"Optimising the dosimetric quality and efficiency of post-prostatectomy radiotherapy: A planning study comparing the performance of volumetric-modulated arc therapy (VMAT) with an optimised seven-field intensity-modulated radiotherapy (IMRT) technique","volume":"56","author":"Nguyen","year":"2012","journal-title":"J. Med. Imaging Radiat. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1002\/acm2.13233","article-title":"Analysis of prostate intensity- and volumetric-modulated arc radiation therapy planning quality with PlanIQ\u2122","volume":"22","author":"Sasaki","year":"2021","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"20230020","DOI":"10.1259\/bjr.20230020","article-title":"The dosimetric underpinning of bladder filling criteria for prostate image-guided volumetric modulated arc therapy","volume":"96","author":"Kong","year":"2023","journal-title":"Br. J. Radiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"101","DOI":"10.14316\/pmp.2022.33.4.101","article-title":"Minimization of Treatment Time Using Partial-Arc Volumetric Modulated Arc Therapy with Bladder Filling Protocol for Prostate Cancer","volume":"33","author":"Lee","year":"2022","journal-title":"Prog. Med. Phys."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/1\/13\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:41:36Z","timestamp":1760132496000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/1\/13"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,19]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["cancers16010013"],"URL":"https:\/\/doi.org\/10.3390\/cancers16010013","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,19]]}}}