Challenges in lung and heart avoidance for postmastectomy breast cancer radiotherapy: Is automated planning the answer?

Cilla, Savino; Macchia, G.; Romano, Carmela; Morabito, V.E.; Boccardi, M.; Picardi, V.; Valentini, Vincenzo; Morganti, Alessio Giuseppe; Deodato, Francesco

doi:10.1016/j.meddos.2021.03.002

Cited by 12 publications

(21 citation statements)

References 24 publications

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“…Cilla et al looked at automated Pinnacle VMAT planning for chest wall and nodes and found plans were produced under 30 min with lower OAR doses. 24 Van Duren-Koopman used hybrid tangents with superior nodal VMAT scripting in Eclipse TPS to produce comparable plans with only 5 min interaction time. 25 Our work provides us with the ability to produce near finished plans with minimal manual effort.…”

Section: Discussionmentioning

confidence: 99%

Implementation of automated personalised breast radiotherapy planning techniques with scripting in Raystation

Gleeson

Bolger

Chun

et al. 2023

BJR

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Objectives: Implement scripted automatic breast planning (AP) for breast techniques within Raystation. Methods: Manual plans (MP) were re-planned and compared with AP plans for whole breast (WB), partial breast (PB), hybrid VMAT SIB and VMAT nodal plans. Results: WB AP plans took 7 min comparing well to MP. One WB AP failed a mandatory dose constraint. Small statistically significant differences showed improved coverage for AP at expense of slightly hotter plans, however absolute differences were small (mean differences < 1% or D 0.5cc <0.2 Gy). PB AP plans took 9 min, showing improved coverage (V 24.7Gy97.6versus 96.4 %). One PB AP case failed a mandatory constraint. Other dosimetric differences were non-significant. SIB AP plans took 14 mins with one case failing a mandatory constraint with minor differences compared with MP except larger V 42.8Gy (3vs 1.5 %) and more μ. VMAT AP plans took 12 mins and were hotter for PTVp_4000 but had higher nodal coverage. Contra_Lung V 2.5Gy was higher (8.8 %) than MP plans (6.5 %). Conclusion: Automatic planning of modern breast techniques has been successfully introduced using a commercial planning system. AP plans are very similar to MP, requiring little manual interaction for most cases with significant timesaving potential. Advances in knowledge: Scripted breast plans produced within minutes for WB, PB, SIB and VMAT. Successfully introduced into large busy department. Plans similar to manual plans, requiring little manual interaction.

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Section: Discussionmentioning

confidence: 99%

Implementation of automated personalised breast radiotherapy planning techniques with scripting in Raystation

Gleeson

Bolger

Chun

et al. 2023

BJR

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“…( 13 ) and Cilla et al. ( 17 ), since the cases in this study included the internal mammary region, and higher generalization is required for automated treatment planning, the setting of the gantry angle range is slightly larger, ranging from 294 to 180 degrees for the left-sided postmastectomy VMAT plans and 181 to 66 degrees for the right-sided postmastectomy VMAT plans. Because the dose rate and field aperture at each gantry angle can be well modulated for VMAT, and the jaw tracking mode is used to reduce the leakage dose, the low-dose volume can be controlled well while ensuring the dose conformity and uniformity of the target volume.…”

Section: Discussionmentioning

confidence: 91%

“…Cilla et al. ( 17 ) conducted a preliminary feasibility study of automated treatment planning of left-sided postmastectomy VMAT.…”

Section: Introductionmentioning

confidence: 99%

Artificial Intelligence-Based Automated Treatment Planning of Postmastectomy Volumetric Modulated Arc Radiotherapy

Jiang

Yang

et al. 2022

Front. Oncol.

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As a useful tool, artificial intelligence has surpassed human beings in many fields. Artificial intelligence-based automated radiotherapy planning strategies have been proposed in lots of cancer sites and are the future of treatment planning. Postmastectomy radiotherapy (PMRT) decreases local recurrence probability and improves overall survival, and volumetric modulated arc therapy (VMAT) has gradually become the mainstream technique of radiotherapy. However, there are few customized effective automated treatment planning schemes for postmastectomy VMAT so far. This study investigated an artificial intelligence based automated planning using the MD Anderson Cancer Center AutoPlan (MDAP) system and Pinnacle treatment planning system (TPS), to effectively generate high-quality postmastectomy VMAT plans. In this study, 20 patients treated with PMRT were retrospectively investigated, including 10 left- and 10 right-sided postmastectomy patients. Chest wall and the supraclavicular, subclavicular, and internal mammary regions were delineated as target volume by radiation oncologists, and 50 Gy in 25 fractions was prescribed. Organs at risk including heart, spinal cord, left lung, right lung, and lungs were also contoured. All patients were planned with VMAT using 2 arcs. An optimization objective template was summarized based on the dose of clinical plans and requirements from oncologists. Several treatment planning parameters were investigated using an artificial intelligence algorithm, including collimation angle, jaw collimator mode, gantry spacing resolution (GSR), and number of start optimization times. The treatment planning parameters with the best performance or that were most preferred were applied to the automated treatment planning method. Dosimetric indexes of automated treatment plans (autoplans) and manual clinical plans were compared by the paired t-test. The jaw tracking mode, 2-degree GSR, and 3 rounds of optimization were selected in all the PMRT autoplans. Additionally, the 350- and 10-degree collimation angles were selected in the left- and right-sided PMRT autoplans, respectively. The uniformity index and conformity index of the planning target volume, mean heart dose, spinal cord D0.03cc, mean lung dose, and V5Gy and V20Gy of the lung of autoplans were significantly better compared with the manual clinical plans. An artificial intelligence-based automated treatment planning method for postmastectomy VMAT has been developed to ensure plan quality and improve clinical efficiency.

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“…VMAT, on the other hand, uses intensity modulated arcs to deliver a radiation dose more consistent with target volumes (breast and nodes), reduces outside targets high doses but increases low doses. By combining these techniques, a hybrid approach can deliver a radiation dose more consistent with target volumes 20 , reduce doses to normal tissues Ashby and Bridge 21 and reduce the risk of long-term toxicity Cilla et al 22 . The decision to use a hybrid approach should be selective and reserved for certain patients 23 and treatments 24 with nodes irradiation for example 25 .…”

Section: The Choice Of Hybrid Approach (3dcrt and Vmat)mentioning

confidence: 99%

Hybrid VMAT-3DCRT as Breast Treatment Improvement Tool

Voyant¹,

Pinpin²,

Leschi³

et al. 2023

Preprint

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Challenges in lung and heart avoidance for postmastectomy breast cancer radiotherapy: Is automated planning the answer?

Cited by 12 publications

References 24 publications

Implementation of automated personalised breast radiotherapy planning techniques with scripting in Raystation

Implementation of automated personalised breast radiotherapy planning techniques with scripting in Raystation

Artificial Intelligence-Based Automated Treatment Planning of Postmastectomy Volumetric Modulated Arc Radiotherapy

Hybrid VMAT-3DCRT as Breast Treatment Improvement Tool

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