A multi‐institutional study to assess adherence to lung stereotactic body radiotherapy planning goals

Woerner, Andrew; Roeske, John C.; Harkenrider, Matthew M.; Fan, John C. C.; Aydogan, Bulent; Koshy, Matthew; Laureckas, R; Vali, F.; Campaña, María Elena Meda; Sürücü, Murat

doi:10.1118/1.4926551

Cited by 6 publications

(7 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results suggest that the RTOG 0813 R100% constraint levels are set too high to usefully detect sub-optimal plans, as the "tolerance" constraint was only exceeded by 8 of 147 (5%) plans and no submissions exceeded the "minor deviation" constraint. This is better conformity than was reported in a study of 300 lung SBRT plans from 4 centers [34] which found that only 79% of plans achieved the RTOG 0813 "tolerance" constraint (R100% 1.14 ± 0.21 (mean ± SD)). The ROSEL study R100% constraint levels are supported by these data, as they closely match the CtE data median plus 1 SD and median plus 2 SD, although we have chosen to increase some of the ROSEL values slightly to reflect the results and the fact the PDS denominator is the PTV V100%, rather than the PTV volume (which will be cause the PDS value to rise slightly).…”

Section: Discussioncontrasting

confidence: 47%

“…These data suggest that these constraints are not routinely achievable. The recent study of 300 lung SBRT plans supports this, with 43% exceeding RTOG 0813 R50% "tolerance" and 66% exceeding "minor deviation" levels [34]. The RTOG 0813 constraints in general appear to be mis-matched to the gathered data, with the R100% constraints being too lax (particularly for larger PTVs), and the R50% constraints being Table 1 Conformity metrics for all 147 plans submitted through the CtE programme, split by PTV V100% volume range.…”

Section: Discussionmentioning

confidence: 92%

See 1 more Smart Citation

Multi-center evaluation of dose conformity in stereotactic body radiotherapy

Lee

Dean

Patel

et al. 2019

Physics and Imaging in Radiation Oncology

View full text Add to dashboard Cite

Background and purpose: Stereotactic body radiotherapy (SBRT) is an emerging technique for treating oligometastases, but limited data is available on what plan quality is achievable for a range of modalities and clinical sites. Methods: SBRT plans for lung, spine, bone, adrenal, liver and node sites from 17 participating centers were reviewed. Centers used various delivery techniques including static and rotational intensity-modulation and multiple non-coplanar beams. Plans were split into lung and other body sites and evaluated with different plan quality metrics, including two which are independent of target coverage; "prescription dose spillage" (PDS) and "modified gradient index" (MGI). These were compared to constraints from the ROSEL and RTOG 0813 clinical trials. Results: Planning target volume (PTV) coverage was compromised (PTV V100% < 90%) in 29% of patient plans in order to meet organ-at-risk (OAR) tolerances, supporting the use of plan quality metrics which are independent of target coverage. Both lung (n = 48) and other body (n = 99) site PDS values agreed well with ROSEL constraints on dose spillage, but RTOG 0813 values were too high to detect sub-optimal plans. MGI values for lung plans were mis-matched to both sets of previous constraints, with ROSEL values too high and RTOG 0813 values too low. MGI values were lower for other body plans as expected, though this was only statistically significant for PTV volumes < 20 cm 3. Conclusions: Updated guidance for lung and other body site SBRT plan quality using the PDS and MGI metrics is presented.

show abstract

Section: Discussioncontrasting

confidence: 47%

Section: Discussionmentioning

confidence: 92%

Multi-center evaluation of dose conformity in stereotactic body radiotherapy

Lee

Dean

Patel

et al. 2019

Physics and Imaging in Radiation Oncology

View full text Add to dashboard Cite

show abstract

“…While lung SBRT has been demonstrated to be highly successful in achieving local control, the use of more potent (and, arguably more effective) SBRT fractionation schema as well as the administration of SBRT to more centrally-located lesions are limited in practice because of potential toxicity to surrounding tissues. 25,26 The applications of SBRT can be potentially further expanded by creating treatment plans with improved OAR-sparing and, hence, lowered toxicity. The 4D planning concept can be independently applied to most commonly deployed treatment delivery techniques, e.g.…”

Section: Discussionmentioning

confidence: 99%

Inverse‐planned deliverable 4D‐IMRT for lung SBRT

et al. 2018

View full text Add to dashboard Cite

show abstract

“…In a multicenter study, they found significant differences for target coverage and OAR sparing due to different optimization strategies selected by the planners. Another multi-institutional study evaluated dosimetric parameters for SBRT of lung lesions and how much the guidelines provided in the literature are being successfully implemented in a variety of clinics [ 37 ]. They analyzed PTV coverage and conformality of their treatment plan and found that and the conformality index of 50 % was the most difficult to meet depending on tumor size and location.…”

Section: Discussionmentioning

confidence: 99%

Variability in spine radiosurgery treatment planning – results of an international multi-institutional study

et al. 2016

View full text Add to dashboard Cite

BackgroundThe aim of this study was to quantify the variability in spinal radiosurgery (SRS) planning practices between five international institutions, all member of the Elekta Spine Radiosurgery Research Consortium.MethodsFour institutions provided one representative patient case each consisting of the medical history, CT and MR imaging. A step-wise planning approach was used where, after each planning step a consensus was generated that formed the basis for the next planning step. This allowed independent analysis of all planning steps of CT-MR image registration, GTV definition, CTV definition, PTV definition and SRS treatment planning. In addition, each institution generated one additional SRS plan for each case based on intra-institutional image registration and contouring, independent of consensus results.ResultsAveraged over the four cases, image registration variability ranged between translational 1.1 mm and 2.4 mm and rotational 1.1° and 2.0° in all three directions. GTV delineation variability was 1.5 mm in axial and 1.6 mm in longitudinal direction averaged for the four cases. CTV delineation variability was 0.8 mm in axial and 1.2 mm in longitudinal direction. CTV-to-PTV margins ranged between 0 mm and 2 mm according to institutional protocol. Delineation variability was 1 mm in axial directions for the spinal cord. Average PTV coverage for a single fraction18 Gy prescription was 87 ± 5 %; Dmin to the PTV was 7.5 ± 1.8 Gy averaged over all cases and institutions. Average Dmax to the PRV_SC (spinal cord + 1 mm) was 10.5 ± 1.6 Gy and the average Paddick conformity index was 0.69 ± 0.06.ConclusionsResults of this study reflect the variability in current practice of spine radiosurgery in large and highly experienced academic centers. Despite close methodical agreement in the daily workflow, clinically significant variability in all steps of the treatment planning process was demonstrated. This may translate into differences in patient clinical outcome and highlights the need for consensus and established delineation and planning criteria.

show abstract

A multi‐institutional study to assess adherence to lung stereotactic body radiotherapy planning goals

Abstract: Among the various parameters that were used to evaluate the SBRT plans, the CI100% and CI50% were the most challenging criteria to meet. Although the CSRs of organs at risk were higher among all cases, their proximity to the PTV was a significant factor.

Cited by 6 publications

References 21 publications

Multi-center evaluation of dose conformity in stereotactic body radiotherapy

Multi-center evaluation of dose conformity in stereotactic body radiotherapy

Inverse‐planned deliverable 4D‐IMRT for lung SBRT

Variability in spine radiosurgery treatment planning – results of an international multi-institutional study

Contact Info

Product

Resources

About