OC-0521 SRS plan quality with variation in modality: Results of an international planning competition

Hardcastle, Nicholas; Nelms, Benjamin E.; O'Connor, Lorna; Shakeshaft, John; Haworth, Annette; Cook, O.; Harris, M.; Phillips, Curtis

doi:10.1016/s0167-8140(19)30941-7

Cited by 6 publications

(5 citation statements)

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“…The platforms and planning systems, listed in Table 2 have been dosimetrically compared at length in literature both in the context of treating a single lesion and more recently for MIM. 71–77 Planning studies using a single case planned across multiple treatment planning systems have also been completed 78 focusing differet planning techniques but excluding the impact of the technology delivering the plan. The strength of evidence demonstrating superiority in plan or treatment quality of one platform over the other has been low.…”

Section: Discussion Of Clinical Cases and Clinical Evaluation Of Mim Treatment Platforms And Tpsmentioning

confidence: 99%

Treatment of multiple intracranial metastases in radiation oncology: a contemporary review of available technologies

Skourou¹,

Hickey²,

Rock³

et al. 2021

BJR|Open

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The use of stereotactic radiosurgery to treat multiple intracranial metastases, frequently concurrently, has become increasingly common. The ability to accurately and safely deliver stereotactic radiosurgery treatment to multiple intracranial metastases (MIM) relies heavily on the technology available for targeting, planning, and delivering the dose. A number of platforms are currently marketed for such applications, each with intrinsic capabilities and limitations. These can be broadly categorised as cobalt-based, linac-based, and robotic. This review describes the most common representative technologies for each type along with their advantages and current limitations as they pertain to the treatment of multiple intracranial metastases. Each technology was used to plan five clinical cases selected to represent the clinical breadth of multiple metastases cases. The reviewers discuss the different strengths and limitations attributed to each technology in the case of MIM as well as the impact of disease-specific characteristics (such as total number of intracranial metastases, their size and relative proximity) on plan and treatment quality.

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Section: Discussion Of Clinical Cases and Clinical Evaluation Of Mim Treatment Platforms And Tpsmentioning

confidence: 99%

Treatment of multiple intracranial metastases in radiation oncology: a contemporary review of available technologies

Skourou¹,

Hickey²,

Rock³

et al. 2021

BJR|Open

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“…The impact of a variety of delivery errors were assessed for multiple-target brain SRS plans obtained through the Trans-Tasman Radiation Oncology Group (TROG) treatment planning challenge in 2018. 16 In this challenge, CT and RTSTRUCT files for a single patient were provided to all participants, who performed a treatment plan according to a pre-defined protocol and scoring matrix (see supplementary material). The challenge patient had five targets, each with a prescription of 20 Gy.…”

Section: Methodsmentioning

confidence: 99%

Multi‐institutional investigation into the robustness of intra‐cranial multi‐target stereotactic radiosurgery plans to delivery errors

May,

Hardcastle,

Hernandez

et al. 2023

Medical Physics

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BackgroundThe use of modulated techniques for intra‐cranial stereotactic radiosurgery (SRS) results in highly modulated fields with small apertures, which may be susceptible to uncertainties in the delivery device.PurposeThis study aimed to quantify the impact of simulated delivery errors on treatment plan dosimetry and how this is affected by treatment planning system (TPS), plan geometry, delivery technique, and plan complexity. A beam modelling error was also included as context to the dose uncertainties due to treatment delivery errors.MethodsDelivery errors were assessed for multiple‐target brain SRS plans obtained through the Trans‐Tasman Radiation Oncology Group (TROG) international treatment planning challenge (2018). The challenge dataset consisted of five intra‐cranial targets, each with a prescription of 20 Gy. Of the final dataset of 54 plans, 51 were created using the volumetric modulated arc therapy (VMAT) technique and three used intensity modulated arc therapy (IMRT). Thirty‐five plans were from the Varian Eclipse TPS, 17 from Elekta Monaco TPS, and one plan each from RayStation and Philips Pinnacle TPS. The errors introduced included: monitor unit calibration errors, multi‐leaf collimator (MLC) bank offset, single MLC leaf offset, couch rotations, and collimator rotations. Dosimetric leaf gap (DLG) error was also included as a beam modelling error. Dose to targets was assessed via dose covering 98% of planning target volume (PTV) (D98%), dose covering 2% of PTV (D2%), and dose covering 99% of gross tumor volume (GTV) (D99%). Dose to organs at risk (OARs) was assessed using the volume of normal brain receiving 12 Gy (V12Gy), mean dose to normal brain, and maximum dose covering 0.03cc brainstem (D0.03cc). Plan complexity was also assessed via edge metric, modulation complexity score (MCS), mean MLC gap, mean MLC speed, and plan modulation (PM).ResultsPTV D98% showed high robustness on average to most errors with the exception of a bank shift of 1.0 mm and large rotational errors ≥1.0° for either the couch or collimator. However, in some cases, errors close to or within generally accepted machine tolerances resulted in clinically relevant impacts. The greatest impact upon normal brain V12Gy, mean dose to normal brain, and D0.03cc brainstem was found for DLG error in alignment with other recent studies. All delivery errors had on average a minimal impact across these parameters. Comparing plans from the Monaco TPS and the Eclipse TPS, showed a lesser increase to V12Gy, mean dose to normal brain, and D0.03cc brainstem for Monaco plans (p < 0.01) when DLG error was simulated. Monaco plans also correlated to lower plan complexity. Using Spearman's correlation coefficient (r) a strong negative correlation (r ≤ −0.8) was found between the mean MLC gap and dose to OARs for DLG errors.ConclusionsReducing MLC complexity and using larger mean MLC gaps is recommended to improve plan robustness and reduce sensitivity to delivery and modelling errors. For cases in which the calculated dose distribution or dose indices are close to the clinically acceptable limits, this is especially important.

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“…The study case was originally from the Local-HER-0 trial protocol [6] and was used in a prior international planning competition hosted by the ProKnow 1 system. Details of this study case was described in [5,7].…”

Section: Methodsmentioning

confidence: 99%

Sub-analysis of multi-center planning radiosurgery for intracranial metastases through automation (MC-PRIMA) comparing plan quality between UK and International Centers

Chan

2022

Preprint

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Objectives A sub-analysis of the MC-PRIMA study was performed to compare the plan quality of stereotactic radiosurgery (SRS) to brain metastases between UK and other international centers. Methods and materials: Six SRS centers from the UK and nineteen from other international centers autoplanned using the Multiple Brain Mets software for a five brain metastases study case from the planning competition that was originally organized by the Trans-Tasmania Radiation Oncology Group (TROG). 23 dosimetric metrics and the resulting composite plan score (maximum 150) per the TROG planning competition were compared between the UK and the other international centers. Planning experience and planning time from each planner were recorded and compared. Results Planning experiences between two groups are equal. Except for mean dose to the hippocampus, all other 22 dosimetric metrics were comparable between the UK and the other international centers. The inter-planner variations in these 23 dosimetric metrics and the composite plan score were also statistically equivalent. Planning time is slightly longer in the UK group (mean = 86.8 minutes ) with a mean difference of 50.3 minutes. Conclusions Autoplanning effectively achieves standardization of the plan quality of SRS to multiple brain metastases within UK and further against other international centers. Significant planning efficiency gain may help to increase the capacity of SRS service by alleviating the clinical and technical loadings.

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OC-0521 SRS plan quality with variation in modality: Results of an international planning competition

Cited by 6 publications

References 0 publications

Treatment of multiple intracranial metastases in radiation oncology: a contemporary review of available technologies

Treatment of multiple intracranial metastases in radiation oncology: a contemporary review of available technologies

Multi‐institutional investigation into the robustness of intra‐cranial multi‐target stereotactic radiosurgery plans to delivery errors

Sub-analysis of multi-center planning radiosurgery for intracranial metastases through automation (MC-PRIMA) comparing plan quality between UK and International Centers

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