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Moustakis, Christos; Blanck, Oliver; Chan, Mark Ka Heng; Boda-Heggemann, Judit; Andratschke, Nicolaus; Duma, Marciana-Nona; Albers, Dirk; Baeumer, Christian; Fehr, Roman; Koerber, Stefan A.; Schmidhalter, Daniel; Alraun, Manfred; Baus, Wolfgang W.; Beckers, Eric; Dierl, Mathias; Droege, Stephan; Tazehmahalleh, Fatemeh Ebrahimi; Fleckenstein, Jens; Guckenberger, Matthias; Heinz, Christian; Henkenberens, Christoph; Hennig, Andreas; Koehn, Janett; Kornhuber, Christine; Krieger, Thomas; Loutfi-Krauss, Britta; Mayr, Manfred; Oechsner, Markus; Pfeiler, Tina; Pollul, Gerhard; Schoeffler, Juergen; Tuemmler, Heiko; Ullm, Claudia; Walke, Mathias; Weigel, Rocco; Wertman, Martin; Wiehle, Rolf; Wiezorek, Tilo; Wilke, Lotte; Wolf, Ulrich; Eich, Hans Theodor and Schmitt, Daniela (2022): Planning Benchmark Study for Stereotactic Body Radiation Therapy of Liver Metastases: Results of the DEGRO/DGMP Working Group on Stereotactic Radiation Therapy and Radiosurgery. In: International Journal of Radiation Oncology Biology Physics, Vol. 113, No. 1: pp. 214-227

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Purpose: Our purpose was to investigate whether liver stereotactic body radiation therapy treatment planning can be harmonized across different treatment planning systems, delivery techniques, and institutions by using a specific prescription method and to minimize the knowledge gap concerning intersystem and interuser differences. We provide best practice guidelines for all used techniques. Methods and Materials: A multiparametric specification of target dose (gross target volume [GTV](D50%), GTV(D0.1cc), GTV(V90%), planning target volume [PTV](V70%)) with a prescription dose of GTV(D50% )= 3 x 20 Gy and organ-at-risk (OAR) limits were distributed with computed tomography and structure sets from 3 patients with liver metastases. Thirty-five institutions provided 132 treatment plans using different irradiation techniques. These plans were first analyzed for target and OAR doses. Four different renormalization methods were performed (PTVDmin, PTVD98%, PTVD2% , PTVDmax). The resulting 660 treatments plans were evaluated regarding target doses to study the effect of dose renormalization to different prescription methods. A relative scoring system was used for comparisons. Results: GTV(D50%) prescription can be performed in all systems. Treatment plan harmonization was overall successful, with standard deviations for Dmax, PTVD98%, GTV(D98%), and PTVDmean of 1.6, 3.3, 1.9, and 1.5 Gy, respectively. Primary analysis showed 55 major deviations from clinical goals in 132 plans, whereas in only <20% of deviations GTV/PTV dose was traded for meeting OAR limits. GTV(D50%) prescription produced the smallest deviation from target planning objectives and between techniques, followed by the PTVDmax, PTVD98%, PTVD2%, and PTV(Dmin )prescription. Deviations were significant for all combinations but for the PTVDmax prescription compared with GTV(D50%) and PTVD98%. Based on the various dose prescription methods, all systems significantly differed from each other, whereas GTV(D50%) and PTVD98% prescription showed the least difference between the systems. Conclusions: This study showed the feasibility of harmonizing liver stereotactic body radiation therapy treatment plans across different treatment planning systems and delivery techniques when a sufficient set of clinical goals is given. (C) 2022 Elsevier Inc. All rights reserved.

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