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Purpose: To quantitatively compare the dosimetric and biologic differences intreatment plans from flattened and flattening-filter-free (FFF) beam for threeanatomic cancer sites. Methods and Materials: Treatment plans with staticintensity-modulated radiotherapy beams and volumetric modulated arc therapybeams were generated for 13 patients for both the flattened beam and the FFFbeam of the TrueBeam system. Beam energies of 6 MV and 10 MV were chosen forplanning. A total of 104 treatment plans were generated in 13 patients. Inorder to analyze the biological effectiveness of treatment plans, dose volumehistograms (DVH) were utilized. Flattened and FFF beam plans are quantitativelycompared. Results: In head and neck cases, for VMAT plans, dose reduction inthe FFF beam plans compared to the flattened beam in left cochlea, rightsubmandibular gland and right parotid gland reached up to 2.36 Gy, 1.21 Gy and1.45 Gy, respectively. Similarly, for static IMRT plans, the dose reduction ofthe FFF beam plans compared to the flattened beam plans for the same organsreached up to 0.34 Gy, 1.36 Gy and 1.46 Gy, respectively. Overall, for head andneck, the FFF beam plans achieved mean dose reduction of up to 5%, 7% and 9%,respectively for above organs at risk. For lung and prostate cases, the FFFbeams provided lower or comparable NTCP values to organ-at-risk (OAR) comparedto the flattened beam for all plans. Conclusions: In general, we observedtreatment plans utilizing FFF beams can improve dose sparing to OARs withoutcompromising the target coverage. Significant dose sparing effect is obtainedfor head and neck cancer cases, especially for the cases with relatively largefield sizes (about 16x20 cm^2). For lung and prostate cases, compared to theflattened beam, the FFF beam based treatment plans provide lower or comparabledose to most OARs.

Dosimetric and Biologic Differences in Flattened and Flattening-Filter-Free Beam Treatment Plans