Comparison of VMAT and IMRT strategies for cervical cancer patients using automated planning

Sharfo, A.W.; Voet, P.; Breedveld, S.; Mens, Jan Willem M.; Hoogeman, M.; Heijmen, B.

doi:10.1016/j.radonc.2015.02.006

Cited by 85 publications

(90 citation statements)

References 24 publications

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“…This was different from the study of Cozzi et al, in which the authors stated that RapidArc showed significant improvements in OAR and healthy tissue sparing with uncompromised target coverage compared with conventional five‐field IMRT16. On the contrary, Sharfo et al stated that often reported increased plan quality for VMAT compared to IMRT has not been observed for cervical cancer in their study 17. This differences indicated that the number of fields used for IMRT has a direct impact on the quality of the IMRT plan.…”

Section: Discussionmentioning

confidence: 73%

Dosimetric benefits of intensity‐modulated radiotherapy and volumetric‐modulated arc therapy in the treatment of postoperative cervical cancer patients

Deng

Han

Chen³

et al. 2016

J Applied Clin Med Phys

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As the advantage of using complex volumetric‐modulated arc therapy (VMAT) in the treatment of gynecologic cancer has not yet been fully determined, the purpose of this study was to investigate the dosimetric advantages of VMAT by comparing directly with whole pelvic conformal radiotherapy (CRT) and intensity‐modulated radiotherapy (IMRT) in the treatment of 15 postoperative cervical cancer patients. Four‐field CRT, seven‐field IMRT, and two‐arc VMAT plans were generated for each patient with identical objective functions to achieve clinically acceptable dose distribution. Target coverage and OAR sparing differences were investigated through dose‐volume histogram (DVH) analysis. Nondosimtric differences between IMRT and VMAT were also compared. Target coverage presented by V95% were 88.9% ± 3.8%, 99.9% ± 0.07%, and 99.9% ± 0.1% for CRT, IMRT, and VMAT, respectively. Significant differences on conformal index (CI) and conformal number (CN) were observed with CIs of 0.37 ± 0.07, 0.55 ± 0.04, 0.61 ± 0.04, and CNs of 0.33 ± 0.06, 0.55 ± 0.04, 0.60 ± 0.04 for CRT, IMRT, and VMAT, respectively. IMRT and VMAT decreased the dose to bladder and rectum significantly compared with CRT. No significant differences on the Dmean, V45, and V30 of small bowel were observed among CRT, IMRT, and VMAT. However, VMAT (10.4 ± 4.8 vs. 19.8 ± 11.0, P = 0.004) and IMRT (12.3 ± 5.0 vs. 19.8 ± 11.0, P = 0.02) decreased V40, increased the Dmax of small bowel and the irradiation dose to femoral heads compared with CRT. VMAT irradiated less dose to bladder, rectum, small bowel and larger volume of health tissue with a lower dose (V5 and V10) compared with IMRT, although the differences were not statistical significant. In conclusion, VMAT and IMRT showed significant dosimetric advantages both on target coverage and OAR sparing compared with CRT in the treatment of postoperative cervical cancer. However, no significant difference between IMRT and VMAT was observed except for slightly better dose conformity, slightly less MU, and significant shorter delivery time achieved for VMAT.

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Section: Discussionmentioning

confidence: 73%

Dosimetric benefits of intensity‐modulated radiotherapy and volumetric‐modulated arc therapy in the treatment of postoperative cervical cancer patients

Deng

Han

Chen³

et al. 2016

J Applied Clin Med Phys

View full text Add to dashboard Cite

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“…Next, using the achieved constraint and objective values in the Erasmus-iCycle plan, a patient-specific Monaco template is automatically generated, followed by automated plan generation in Monaco based on this template, to result in a clinically deliverable VMAT plan that closely mimics the initial Erasmus-iCycle plan. The same system is used clinically for automated clinical plan generation for prostate, head and neck, and cervical cancer patients [3, 6, 14]. …”

Section: Methodsmentioning

confidence: 99%

“…Currently, Erasmus-iCycle is clinically applied for IMRT and VMAT plan generation for prostate, head and neck, and cervical cancer patients [3, 6, 14]. The authors have previously demonstrated that automatically generated plans were of noninferior or higher quality compared to plans generated by an expert dosimetrist in the absence of time pressure [3].…”

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confidence: 99%

Fully automated VMAT treatment planning for advanced-stage NSCLC patients

et al. 2017

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PurposeTo develop a fully automated procedure for multicriterial volumetric modulated arc therapy (VMAT) treatment planning (autoVMAT) for stage III/IV non-small cell lung cancer (NSCLC) patients treated with curative intent.Materials and methodsAfter configuring the developed autoVMAT system for NSCLC, autoVMAT plans were compared with manually generated clinically delivered intensity-modulated radiotherapy (IMRT) plans for 41 patients. AutoVMAT plans were also compared to manually generated VMAT plans in the absence of time pressure. For 16 patients with reduced planning target volume (PTV) dose prescription in the clinical IMRT plan (to avoid violation of organs at risk tolerances), the potential for dose escalation with autoVMAT was explored.ResultsTwo physicians evaluated 35/41 autoVMAT plans (85%) as clinically acceptable. Compared to the manually generated IMRT plans, autoVMAT plans showed statistically significant improved PTV coverage (V95% increased by 1.1% ± 1.1%), higher dose conformity (R50 reduced by 12.2% ± 12.7%), and reduced mean lung, heart, and esophagus doses (reductions of 0.9 Gy ± 1.0 Gy, 1.5 Gy ± 1.8 Gy, 3.6 Gy ± 2.8 Gy, respectively, all p < 0.001). To render the six remaining autoVMAT plans clinically acceptable, a dosimetrist needed less than 10 min hands-on time for fine-tuning. AutoVMAT plans were also considered equivalent or better than manually optimized VMAT plans. For 6/16 patients, autoVMAT allowed tumor dose escalation of 5–10 Gy.ConclusionClinically deliverable, high-quality autoVMAT plans can be generated fully automatically for the vast majority of advanced-stage NSCLC patients. For a subset of patients, autoVMAT allowed for tumor dose escalation.

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“…In a previous study [14], our in-house Erasmus-iCycle optimizer was prepared for fully automated multi-criteria generation of treatment plans for cervical cancer patients. These were non-deliverable plans as only fluence optimization was performed (no segmentation).…”

Section: Methodsmentioning

confidence: 99%

Validation of Fully Automated VMAT Plan Generation for Library-Based Plan-of-the-Day Cervical Cancer Radiotherapy

et al. 2016

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PurposeTo develop and validate fully automated generation of VMAT plan-libraries for plan-of-the-day adaptive radiotherapy in locally-advanced cervical cancer.Material and MethodsOur framework for fully automated treatment plan generation (Erasmus-iCycle) was adapted to create dual-arc VMAT treatment plan libraries for cervical cancer patients. For each of 34 patients, automatically generated VMAT plans (autoVMAT) were compared to manually generated, clinically delivered 9-beam IMRT plans (CLINICAL), and to dual-arc VMAT plans generated manually by an expert planner (manVMAT). Furthermore, all plans were benchmarked against 20-beam equi-angular IMRT plans (autoIMRT). For all plans, a PTV coverage of 99.5% by at least 95% of the prescribed dose (46 Gy) had the highest planning priority, followed by minimization of V45Gy for small bowel (SB). Other OARs considered were bladder, rectum, and sigmoid.ResultsAll plans had a highly similar PTV coverage, within the clinical constraints (above). After plan normalizations for exactly equal median PTV doses in corresponding plans, all evaluated OAR parameters in autoVMAT plans were on average lower than in the CLINICAL plans with an average reduction in SB V45Gy of 34.6% (p<0.001). For 41/44 autoVMAT plans, SB V45Gy was lower than for manVMAT (p<0.001, average reduction 30.3%), while SB V15Gy increased by 2.3% (p = 0.011). AutoIMRT reduced SB V45Gy by another 2.7% compared to autoVMAT, while also resulting in a 9.0% reduction in SB V15Gy (p<0.001), but with a prolonged delivery time. Differences between manVMAT and autoVMAT in bladder, rectal and sigmoid doses were ≤ 1%. Improvements in SB dose delivery with autoVMAT instead of manVMAT were higher for empty bladder PTVs compared to full bladder PTVs, due to differences in concavity of the PTVs.ConclusionsQuality of automatically generated VMAT plans was superior to manually generated plans. Automatic VMAT plan generation for cervical cancer has been implemented in our clinical routine. Due to the achieved workload reduction, extension of plan libraries has become feasible.

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Comparison of VMAT and IMRT strategies for cervical cancer patients using automated planning

Cited by 85 publications

References 24 publications

Dosimetric benefits of intensity‐modulated radiotherapy and volumetric‐modulated arc therapy in the treatment of postoperative cervical cancer patients

Dosimetric benefits of intensity‐modulated radiotherapy and volumetric‐modulated arc therapy in the treatment of postoperative cervical cancer patients

Fully automated VMAT treatment planning for advanced-stage NSCLC patients

Validation of Fully Automated VMAT Plan Generation for Library-Based Plan-of-the-Day Cervical Cancer Radiotherapy

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