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In the pursuit of perfect planning: comparison between Lightning Inverse Planning and GammaPlan Wizard for gamma knife radiosurgery

Victor Goulenko

Victor Goulenko

Roswell Park Comprehensive Cancer Center, Radiation MedicineBuffalo, USA
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Goulenko, Victor
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Robert J Plunkett

Robert J Plunkett

Roswell Park Comprehensive Cancer Center, NeurosurgeryBuffalo, USA
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Plunkett, Robert J
, 
Matthew B Podgorsak

Matthew B Podgorsak

Roswell Park Comprehensive Cancer Center, Radiation MedicineBuffalo, USA
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Podgorsak, Matthew B
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Dheerendra Prasad

Dheerendra Prasad

  • Roswell Park Comprehensive Cancer Center, Radiation MedicineBuffalo, USA
  • Roswell Park Comprehensive Cancer Center, NeurosurgeryBuffalo, USA
  • Department of Neurosurgery, Jacobs School of Medicine and Biomedical SciencesBuffalo, USA
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Prasad, Dheerendra
  
21. Juni 2025
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Artikel-Kategorie: research article
Online veröffentlicht: 21. Juni 2025
Seitenbereich: 285 - 292
Eingereicht: 04. Nov. 2025
Akzeptiert: 15. Apr. 2025
DOI: https://doi.org/10.2478/raon-2025-0039
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© 2025 Victor Goulenko et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

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
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

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
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

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
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
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.
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.

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)

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)

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%
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