Analysis of EORTC-1219-DAHANCA-29 trial plans demonstrates the potential of knowledge-based planning to provide patient-specific treatment plan quality assurance

Tol, Jim P.; Dahele, Max; Grégoire, Vincent; Overgaard, Jens; Slotman, Ben J.; Verbakel, Wilko F.A.R.

doi:10.1016/j.radonc.2018.10.005

Cited by 22 publications

(20 citation statements)

References 21 publications

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“…Therefore, this model might be advantageous over single-institutional models, as extrapolations based on contouring differences that would possibly result in poor DVH predictions could be avoided in multi-institutional models. 25 The results listed in Table 2 support this argument, as bias of data submitted from single institutions was clearly identified. Using models built with data submitted from multi-institutions for QA purposes also provides a more realistic peer review and averages out specific opinions and planning patterns of individual institutions.…”

Section: Discussionmentioning

confidence: 67%

“…[18][19][20][21][22] In addition to their use in treatment planning, KBP models have been used as quality assurance (QA) tools in clinical trials. [23][24][25][26] The Imaging and Radiation Oncology Core (IROC) radiation therapy quality assurance center (RTQA), which reviews all treatment plans of patients enrolled in the NRG Oncology clinical trials, started using the available KBP tool for QA of patients' treatment plans. 27 All previous KBP-related studies mentioned previously used institutional treatment plans to train the KBP models and used these models as retrospective QA tools.…”

Section: Introductionmentioning

confidence: 99%

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Offline Quality Assurance for Intensity Modulated Radiation Therapy Treatment Plans for NRG-HN001 Head and Neck Clinical Trial Using Knowledge-Based Planning

Giaddui

Geng

Chen

et al. 2020

Advances in Radiation Oncology

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Purpose This study aimed to investigate whether a disease site–specific, multi-institutional knowledge based-planning (KBP) model can improve the quality of intensity modulated radiation therapy treatment planning for patients enrolled in the head and neck NRG-HN001clinical trial and to establish a threshold of improvements of treatment plans submitted to the clinical trial. Methods and Materials Fifty treatment plans for patients enrolled in the NRG-HN001 clinical trial were used to build a KBP model; the model was then used to reoptimize 50 other plans. We compared the dosimetric parameters of the submitted and KBP reoptimized plans. We compared differences between KBP and submitted plans for single- and multi-institutional treatment plans. Results Mean values for the dose received by 95% of the planning target volume (PTV_6996) and for the maximum dose (D0.03cc) of PTV_6996 were 0.5 Gy and 2.1 Gy higher in KBP plans than in the submitted plans, respectively. Mean values for D0.03cc to the brain stem, spinal cord, optic nerve_R, optic nerve_L, and chiasm were 2.5 Gy, 1.9 Gy, 6.4 Gy, 6.6 Gy, and 5.7 Gy lower in the KBP plans than in the submitted plans. Mean values for D mean to parotid_R and parotid_L glands were 2.2 Gy and 3.8 Gy lower in KBP plans, respectively. In 33 out of 50 KBP plans, we observed improvements in sparing of at least 7 organs at risk (OARs) (brain stem, spinal cord, optic nerves (R & L), chiasm, and parotid glands [R & L]). A threshold of improvement of OARs sparing of 5% of the prescription dose was established for providing the quality assurance results back to the treating institution. Conclusions A disease site–specific, multi-institutional, clinical trial-based KBP model improved sparing of OARs in a large number of reoptimized plans submitted to the NRG-HN001 clinical trial, and the model is being used as an offline quality assurance tool .

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Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Offline Quality Assurance for Intensity Modulated Radiation Therapy Treatment Plans for NRG-HN001 Head and Neck Clinical Trial Using Knowledge-Based Planning

Giaddui

Geng

Chen

et al. 2020

Advances in Radiation Oncology

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“…The suggested objectives should ensure a reasonable plan quality for most patients, although individual patients can likely be optimised further [32]. We deliberately included a range of patient cases, to ensure that results are robust for factors known to impact OAR doses in rectal cancer radiotherapy, such as tumour height, patient positioning [33] and gender [34].…”

Section: Discussionmentioning

confidence: 99%

Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer – A multicentre dose planning study

Appelt

Kerkhof

Nyvang

et al. 2019

Technical Innovations & Patient Support in Radiation Oncolo

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a b s t r a c tBackground and purpose: Organ preservation strategies are increasingly being explored for early rectal cancer. This requires revision of target volumes according to disease stage, as well as new guidelines for treatment planning. We conducted an international, multicentre dose planning study to develop robust planning objectives for modern radiotherapy of a novel mesorectal-only target volume, as implemented in the STAR-TReC trial (NCT02945566). Materials and methods: The published literature was used to establish relevant dose levels for organ at risk (OAR) plan optimisation. Ten representative patients with early rectal cancer were identified. Treatment scans had mesorectal target volumes as well as bowel cavity, bladder and femoral heads outlined, and were circulated amongst the three participating institutions. Each institution produced plans for short course (SCRT, 5 Â 5 Gy) and long course (LCRT, 25 Â 2 Gy) treatment, using volumetric modulated arc therapy on different dose planning systems. Optimisation objectives for OARs were established by determining dose metric objectives achievable for !90% of plans. Results: Sixty plans, all fulfilling target coverage criteria, were produced. The planning results and literature review suggested optimisation objectives for SCRT: V 10Gy < 180 cm 3 , V 18Gy < 110 cm 3 , V 23Gy < 85 cm 3 for bowel cavity; V 21Gy < 15% and V 25Gy < 5% for bladder; and V 12.5Gy < 11% for femoral heads. Corresponding objectives for LCRT: V 20Gy < 180 cm 3 , V 30Gy < 130 cm 3 , V 45Gy < 90 cm 3 for bowel cavity; V 35Gy < 22% and V 50Gy < 7% for bladder; and V 25Gy < 15% for femoral heads. Constraints were validated across all three institutions. Conclusion: We utilized a multicentre planning study approach to develop robust planning objectives for mesorectal radiotherapy for early rectal cancer.

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“…[11][12][13] For example, RapidPlan™(Varian Medical Systems, Palo Alto, CA, USA) has been widely used as a commercial KBP product. 11,14 In the KBP method, the prediction of DVH in new patients requires the use of the DVH of OAR in the previous clinical plan and the parameterized model generated by the relevant anatomical structure, 13,15 thus emphasizing the importance of the parameterized prior model. However, it remains to be seen whether the implementation effect of the parameterized prior model in KBP is consistent under different breathing conditions.…”

Section: Introductionmentioning

confidence: 99%

“…Current studies have proved that KBP has a higher consistency of plan quality and higher operational efficiency than manual plans with different quality 11–13 . For example, RapidPlan™(Varian Medical Systems, Palo Alto, CA, USA) has been widely used as a commercial KBP product 11,14 …”

Section: Introductionmentioning

confidence: 99%

The benefits evaluation of abdominal deep inspiration breath hold based on knowledge‐based radiotherapy treatment planning for left‐sided breast cancer

Wang

Zhao

et al. 2020

J Applied Clin Med Phys

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Purpose To study the impact of abdominal deep inspiration breath hold (DIBH) technique on knowledge‐based radiotherapy treatment planning for left‐sided breast cancer to guide the application of DIBH technology. Materials and methods Two kernel density estimation (KDE) models were developed based on 40 left‐sided breast cancer patients with two CT acquisitions of free breathing (FB‐CT) and DIBH (DIBH‐CT). Each KDE model was used to predict dose volume histograms (DVHs) based on DIBH‐CT and FB‐CT for another 10 new patients similar to our training datasets. The predicted DVHs were taken as a substitute for dose constraints and objective functions in the Eclipse treatment planning system, with the same requirements for the planning target volume (PTV). The mean doses to the heart, the left anterior descending coronary artery (LADCA) and the ipsilateral lung were evaluated and compared using the T‐test among clinical plans, KDE predictions, and KDE plans. Results Our study demonstrated that the KDE model can generate deliverable simulations equivalent to clinically applicable plans. The T‐test was applied to test the consistency hypothesis on another ten left‐sided breast cancer patients. In cases of the same breathing status, there was no statistically significant difference between the predicted and the clinical plans for all clinically relevant DVH indices ( P > 0.05), and all predicted DVHs can be transferred into deliverable plans. For DIBH‐CT images, significant differences were observed between FB model predictions and clinical plans ( P < 0.05). DIBH model prediction cannot be optimized to a deliverable plan based on FB‐CT, with a counsel of perfection. Conclusion KDE models can predict DVHs well for the same breathing conditions but degrade with different breathing conditions. The benefits of DIBH for a given patient can be evaluated with a quick comparison of prediction results of the two models before treatment planning.

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Analysis of EORTC-1219-DAHANCA-29 trial plans demonstrates the potential of knowledge-based planning to provide patient-specific treatment plan quality assurance

Cited by 22 publications

References 21 publications

Offline Quality Assurance for Intensity Modulated Radiation Therapy Treatment Plans for NRG-HN001 Head and Neck Clinical Trial Using Knowledge-Based Planning

Offline Quality Assurance for Intensity Modulated Radiation Therapy Treatment Plans for NRG-HN001 Head and Neck Clinical Trial Using Knowledge-Based Planning

Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer – A multicentre dose planning study

The benefits evaluation of abdominal deep inspiration breath hold based on knowledge‐based radiotherapy treatment planning for left‐sided breast cancer

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