If you were able to improve coverage or minimize hot spots after each optimization attempt

– what was your process? Did you try any new tricks?

To improve the coverage to my PTV and have my hot spot in the prostate bed volume, I cropped
the PTV-68 from extending outside the prostate bed to create a PTV ring. I added a higher
objective to the prostate bed in the optimizer instructing it to give me my highest dose in this
area. I also created Opti volumes around my PTV-56 and PTV-68 to keep the dose volumes from
competing to help with the dose coverage as well.

Was there a metric you were unable to meet, and if so, how did you try to fix it?

I was not able to meet the ideal 5% of the rectum volume receiving 65Gy. I tried to improve this
metric by creating an Opti around the rectum and cropping that from the PTV-68. I also created
Opti's around the PTV’s and made my gantry only go from 200 degrees to 160 degrees compared
to full arcs.
Did you sacrifice points on a specific metric to improve your plan in other areas? What was
your rationale?
I sacrificed points on my bladder metric to meet coverage to my PTV-68. I found that when I
tried to increase the priority on this objective, the coverage to my PTV-68 decreased, which
would not be optimal.