Multi-criteria optimization achieves superior normal tissue sparing in a planning study of intensity-modulated radiation therapy for RTOG 1308-eligible non-small cell lung cancer patients

Kamran, Sophia C.; Mueller, B.; Paetzold, P.; Dunlap, Joseph; Niemierko, Andrzej; Bortfeld, Thomas; Willers, Henning; Craft, David

doi:10.1016/j.radonc.2015.12.028

Cited by 29 publications

(20 citation statements)

References 23 publications

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“…Clinical physician times to coordinate and communicate with planners are on average 2 min for prostate and 5 min for brain cases. Plan review and approval take approximately 5 min for prostate and 10 min for brain cases (complexity comparable to lung tumors, average times published by [ 23 ]). Taking the number of iterations into account, physician times were estimated by 7 min for prostate (N = 1; t ph (CP) = t 3,ph (CP) ≅ 2 + 5 min) and 20–25 min for brain cases (N = 1.5; t ph (CP) = t 3,ph (CP) ≅ 1.5 × 15 min).…”

Section: Resultsmentioning

confidence: 99%

Multicriteria plan optimization in the hands of physicians: a pilot study in prostate cancer and brain tumors

et al. 2017

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BackgroundThe purpose of this study was to demonstrate the feasibility of physician driven planning in intensity modulated radiotherapy (IMRT) with a multicriteria optimization (MCO) treatment planning system and template based plan optimization. Exploiting the full planning potential of MCO navigation, this alternative planning approach intends to improve planning efficiency and individual plan quality.MethodsPlanning was retrospectively performed on 12 brain tumor and 10 post-prostatectomy prostate patients previously treated with MCO-IMRT. For each patient, physicians were provided with a template-based generated Pareto surface of optimal plans to navigate, using the beam angles from the original clinical plans. We compared physician generated plans to clinically delivered plans (created by dosimetrists) in terms of dosimetric differences, physician preferences and planning times.ResultsPlan qualities were similar, however physician generated and clinical plans differed in the prioritization of clinical goals. Physician derived prostate plans showed significantly better sparing of the high dose rectum and bladder regions (p(D1) < 0.05; D1: dose received by 1% of the corresponding structure). Physicians’ brain tumor plans indicated higher doses for targets and brainstem (p(D1) < 0.05). Within blinded plan comparisons physicians preferred the clinical plans more often (brain: 6:3 out of 12, prostate: 2:6 out of 10) (not statistically significant). While times of physician involvement were comparable for prostate planning, the new workflow reduced the average involved time for brain cases by 30%. Planner times were reduced for all cases. Subjective benefits, such as a better understanding of planning situations, were observed by clinicians through the insight into plan optimization and experiencing dosimetric trade-offs.ConclusionsWe introduce physician driven planning with MCO for brain and prostate tumors as a feasible planning workflow. The proposed approach standardizes the planning process by utilizing site specific templates and integrates physicians more tightly into treatment planning. Physicians’ navigated plan qualities were comparable to the clinical plans. Given the reduction of planning time of the planner and the equal or lower planning time of physicians, this approach has the potential to improve departmental efficiencies.

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Section: Resultsmentioning

confidence: 99%

Multicriteria plan optimization in the hands of physicians: a pilot study in prostate cancer and brain tumors

et al. 2017

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“…The robustness of conventional IMPT plans, like ours, is lower since each beam is allowed to treat the complete CTV, which might especially be problematic for the posterior beam and the anterior target portions in the lower neck. Further advanced planning approaches34, 35, 36 and, in particular, robustness analyses36, 37, 38, 39, 40 need to be considered for future studies and to be translated into clinical practice. So far, there is no uniform consensus about the ideal IMPT planning strategy for HNC patients and robust optimization cannot be considered as clinical standard yet.…”

Section: Discussionmentioning

confidence: 99%

Potential proton and photon dose degradation in advanced head and neck cancer patients by intratherapy changes

Stützer

Jakobi

Bandurska-Luque

et al. 2017

J Applied Clin Med Phys

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PurposeEvaluation of dose degradation by anatomic changes for head‐and‐neck cancer (HNC) intensity‐modulated proton therapy (IMPT) relative to intensity‐modulated photon therapy (IMRT) and identification of potential indicators for IMPT treatment plan adaptation.MethodsFor 31 advanced HNC datasets, IMPT and IMRT plans were recalculated on a computed tomography scan (CT) taken after about 4 weeks of therapy. Dose parameter changes were determined for the organs at risk (OARs) spinal cord, brain stem, parotid glands, brachial plexus, and mandible, for the clinical target volume (CTV) and the healthy tissue outside planning target volume (PTV). Correlation of dose degradation with target volume changes and quality of rigid CT matching was investigated.ResultsRecalculated IMPT dose distributions showed stronger degradation than the IMRT doses. OAR analysis revealed significant changes in parotid median dose (IMPT) and near maximum dose (D 1ml) of spinal cord (IMPT, IMRT) and mandible (IMPT). OAR dose parameters remained lower in IMPT cases. CTV coverage (V 95%) and overdose (V 107%) deteriorated for IMPT plans to (93.4 ± 5.4)% and (10.6 ± 12.5)%, while those for IMRT plans remained acceptable. Recalculated plans showed similarly decreased PTV conformity, but considerable hotspots, also outside the PTV, emerged in IMPT cases. Lower CT matching quality was significantly correlated with loss of PTV conformity (IMPT, IMRT), CTV homogeneity and coverage (IMPT). Target shrinkage correlated with increased dose in brachial plexus (IMRT, IMPT), hotspot generation outside the PTV (IMPT) and lower PTV conformity (IMRT).ConclusionsThe study underlines the necessity of precise positioning and monitoring of anatomy changes, especially in IMPT which might require adaptation more often. Since OAR doses remained typically below constraints, IMPT plan adaptation will be indicated by target dose degradations.

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“…either binary decisions on whether plans were clinically acceptable 95,162,169,172 or giving plans a ranking. 93,103,164 Most studies are retrospective, comparing already delivered clinical plans with automatic plans.…”

Section: Clinical Evaluation and Implementation Of Automated Planningmentioning

confidence: 99%

Automation in intensity modulated radiotherapy treatment planning—a review of recent innovations

Hussein

Heijmen

Verellen

et al. 2018

The British Journal of Radiology

180

187

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Radiotherapy treatment planning of complex radiotherapy techniques, such as intensity modulated radiotherapy and volumetric modulated arc therapy, is a resource-intensive process requiring a high level of treatment planner intervention to ensure high plan quality. This can lead to variability in the quality of treatment plans and the efficiency in which plans are produced, depending on the skills and experience of the operator and available planning time. Within the last few years, there has been significant progress in the research and development of intensity modulated radiotherapy treatment planning approaches with automation support, with most commercial manufacturers now offering some form of solution. There is a rapidly growing number of research articles published in the scientific literature on the topic. This paper critically reviews the body of publications up to April 2018. The review describes the different types of automation algorithms, including the advantages and current limitations. Also included is a discussion on the potential issues with routine clinical implementation of such software, and highlights areas for future research.

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Multi-criteria optimization achieves superior normal tissue sparing in a planning study of intensity-modulated radiation therapy for RTOG 1308-eligible non-small cell lung cancer patients

Cited by 29 publications

References 23 publications

Multicriteria plan optimization in the hands of physicians: a pilot study in prostate cancer and brain tumors

Multicriteria plan optimization in the hands of physicians: a pilot study in prostate cancer and brain tumors

Potential proton and photon dose degradation in advanced head and neck cancer patients by intratherapy changes

Automation in intensity modulated radiotherapy treatment planning—a review of recent innovations

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