A method for radiation therapy treatment plan optimization, comprising generating a first radiation therapy treatment plan for a patient using a selected treatment type from a database and optimizing the first radiation therapy treatment plan. A selection of metrics from the first radiation therapy treatment plan are identified and compared to metrics from aggregated prior patient records selected from the database. At least one parameter is identified that affects the ability of the first radiation therapy treatment plan to meet an identified metric. The at least one parameter for the identified metric is compared to at least one parameter for a competing metric and at least one alternative treatment step for the treatment plan is determined that will change the identified at least one parameter to improve the identified metric.
