Development of a multicentre automated model to reduce planning variability in radiotherapy of prostate cancer

Abstract

A B S T R A C TBackground and purpose: Inter-institutional studies highlighted correlation between consistent radiotherapy quality and improved overall patient survival. In treatment planning automation has the potential to address differences due to user-experience and training, promoting standardisation. The aim of this study was to evaluate implementation and clinical effect of a multicentre collaboratively-developed automated planning model for Intensity-Modulated Radiation Therapy/ Volumetric-Modulated Arc Therapy of prostate. The model was built using a variety of public institutions' clinical plans, incorporating different contouring and dose protocols, aiming at minimising their variation. Methods and materials: A model using 110 clinically approved and treated prostate plans provided by different radiotherapy centres was built with RapidPlan (RP), for use on intact and post-prostatectomy prostate cases. The model was validated, distributed and introduced into clinical practice in all institutions. To investigate its impact a total of 126 patients, originally manually inverse planned (OP), were replanned using RP without additional planner manual intervention. Target and organat-risk (OAR) metrics were statistically compared between original and automated plans. Results: For all centres combined and individually, RP provided plans comparable or superior to OP for all dose metrics. Statistically significant reductions with RP were found in bladder (V40Gy) and rectal (V50Gy) low doses (within 2.3% and 3.4% for combined and 4% and 10% individually). No clinically significant changes were seen for the PTV, independently of seminal vesicle inclusion. Conclusion: This project showed it is feasible to develop, share and implement RP models created with plans from different institutions treated with a variety of techniques and dose protocols, with the potential of improving treatment planning results and/or efficiency despite the original variability.

Personalising treatment plan quality review with knowledge-based planning in the TROG 15.03 trial for stereotactic ablative body radiotherapy in primary kidney cancer

“…The model has learned achievable dose volume histograms from a library of plans, in which OAR dose depends on the geometric relationship between a target and OAR, beam geometry and prescription dose. KBP has been used to improve the consistency and efficiency of treatment planning in routine practice, to audit treatment plan quality within and external to an institution, and to retrospectively review treatment plan quality in clinical trials [10,[13][14][15][16][17][18][19][20][21]. In retrospective review of clinical trial data, the potential of KBP to improve individual patient OAR dosimetry has been demonstrated [13,16,17,[22][23][24].…”

An updating approach for knowledge‐based planning models to improve plan quality and variability in volumetric‐modulated arc therapy for prostate cancer

“…[2][3][4][5] RapidPlan (RP) which is integrated in the Eclipse treatment planning system (TPS) (Varian Medical Systems, Palo Alto, CA, USA) is a specific knowledge-based planning (KBP) solution that can reduce the variation of dose-volume parameters and ensure planning consistency between planners and institutions. [6][7][8][9][10][11] Many studies reported that RP using a single optimization of dose-volume parameters and dose distributions can produce IMRT/VMAT plans superior or comparable to clinically accepted plans for various treatment sites. [12][13][14][15][16][17][18][19][20][21][22][23][24][25] The RP model performance, such as sparing of OARs, depends on the training plans included in the model library; therefore, the registration of better plans is useful to update the model and enhance its performance.…”

“…However, coverage of the target and sparing of the organs at risks (OARs) with inverse planning depends on the planner's or institution's experience and protocol compliance, and can therefore compromise the gains of high‐precision radiotherapy 2–5 . RapidPlan (RP) which is integrated in the Eclipse treatment planning system (TPS) (Varian Medical Systems, Palo Alto, CA, USA) is a specific knowledge‐based planning (KBP) solution that can reduce the variation of dose–volume parameters and ensure planning consistency between planners and institutions 6‐11 12‐25 …”

“… 2 , 3 , 4 , 5 RapidPlan (RP) which is integrated in the Eclipse treatment planning system (TPS) (Varian Medical Systems, Palo Alto, CA, USA) is a specific knowledge‐based planning (KBP) solution that can reduce the variation of dose–volume parameters and ensure planning consistency between planners and institutions. 6 , 7 , 8 , 9 , 10 , 11 Many studies reported that RP using a single optimization of dose–volume parameters and dose distributions can produce IMRT/VMAT plans superior or comparable to clinically accepted plans for various treatment sites. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25…”

Advanced treatment planning strategies to enhance quality and efficiency of radiotherapy

“…a contoured planning CT-scan. Panettieri et al [20] presented in this journal their results on a multi-centric investigation where a KBP model for prostate (based on commercial planning system) was developed, trained and validated by two centers and then distributed, re-validated according to local practice guidelines and then utilized clinically by six other institutions. The authors suggested the feasibility of developing and implementing at a multi-centric level an automated planning workflow.…”