Improved Dosimetry and Plan Quality for Accelerated Partial Breast Irradiation Using Online Adaptive Radiation Therapy: A Single Institutional Study

Pogue, Joel A.; Cardenas, Carlos E.; Stanley, Dennis N.; Stanley, Courtney; Hotsinpiller, Whitney; Veale, Christopher; Soike, Michael H.; Popple, Richard A.; Boggs, Drexell H.; Harms, Joseph

doi:10.1016/j.adro.2023.101414

Cited by 1 publication

(4 citation statements)

References 31 publications

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“…Ref (initial plans based on simulation CT), mean SOC (ref plans recalculated onto daily anatomy), mean Del metrics (choice of either the SOC or daily adapted plan), and statistical comparisons are summarized in supplemental table S1, which are consistent with previous findings favoring OART for APBI (Pogue et al 2023b). Lineplots showing Ref, SOC, and Del plan metrics for individual patients, as well as median and interquartile range values, are shown in figure 2.…”

Section: Effect Of Adaption On Plan Qualitysupporting

confidence: 77%

“…In addition to trends in adaptive benefit tied to the structure of our optimization template, PTV volume shrinkage and deformation are considered primary drivers of adaptive benefit, as discussed and illustrated at length previously (Pogue et al 2023b). The median PTV shrinkage at adaption relative to simulation was 13.2% for this 31-target cohort.…”

Section: Discussionmentioning

confidence: 90%

“…Lastly, the Mobius3D-Adapt (Varian Medical Systems, Palo Alto, CA) secondary calculation algorithm was used to verify correct plan MUs, a 5%/3 mm global gamma value above 95% (using a 10% threshold), and less than 5% mean and D90% difference between algorithms for all target structures, according to department guidelines (Zhao et al 2023). Based on a previous study from our institution, the reference planning (from simulation to first treatment, including weekends) and online planning/delivery processes (from initial CBCT to end of beam delivery) required median times of 26 d and 31 min, respectively (Pogue et al 2023b).…”

Section: Online Adaptive Workflowmentioning

confidence: 99%

“…A comparison of Ref, SOC, and Del (i.e. the plans selected for treatment) dose metrics and planning objective compliance has previously been published by our institution for a sequential 21-target cohort (Pogue et al 2023b). Because our intent was demonstrating net improvement with adaptive capabilities, and because the SOC plan was superior to the adaptive plan in some cases, Del plans were compared to SOC and Ref plans, as opposed to exclusively comparing adaptive plans.…”

Section: Dose-volume Metricsmentioning

confidence: 99%

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Unlocking the adaptive advantage: correlation and machine learning classification to identify optimal online adaptive stereotactic partial breast candidates

Pogue,

Harms,

Cardenas

et al. 2024

Phys. Med. Biol.

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Objective. Online adaptive radiotherapy (OART) is a promising technique for delivering stereotactic accelerated partial breast irradiation (APBI), as lumpectomy cavities vary in location and size between simulation and treatment. However, OART is resource-intensive, increasing planning and treatment times and decreasing machine throughput compared to the standard of care (SOC). Thus, it is pertinent to identify high-yield OART candidates to best allocate resources. Approach. Reference plans (plans based on simulation anatomy), SOC plans (reference plans recalculated onto daily anatomy), and daily adaptive plans were analyzed for 31 sequential APBI targets, resulting in the analysis of 333 treatment plans. Spearman correlations between 22 reference plan metrics and 10 adaptive benefits, defined as the difference between mean SOC and delivered metrics, were analyzed to select a univariate predictor of OART benefit. A multivariate logistic regression model was then trained to stratify high- and low-benefit candidates.Main Results. Adaptively delivered plans showed dosimetric benefit as compared to SOC plans for most plan metrics, although the degree of adaptive benefit varied per patient. The univariate model showed high likelihood for dosimetric adaptive benefit when the reference plan ipsilateral breast V15Gy exceeds 23.5%. Recursive feature elimination identified 5 metrics that predict high-dosimetric-benefit adaptive patients. Using leave-one-out cross validation, the univariate and multivariate models classified targets with 74.2% and 83.9% accuracy, resulting in improvement in per-fraction adaptive benefit between targets identified as high- and low-yield for 7/10 and 8/10 plan metrics, respectively. Significance. This retrospective, exploratory study demonstrated that dosimetric benefit can be predicted using only ipsilateral breast V15 Gy on the reference treatment plan, allowing for a simple, interpretable model. Using multivariate logistic regression for adaptive benefit prediction led to increased accuracy at the cost of a more complicated model. This work presents a methodology for clinics wishing to triage OART resource allocation.

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Section: Effect Of Adaption On Plan Qualitysupporting

confidence: 77%

Section: Discussionmentioning

confidence: 90%