Offline Quality Assurance for Intensity Modulated Radiation Therapy Treatment Plans for NRG-HN001 Head and Neck Clinical Trial Using Knowledge-Based Planning

Abstract

Purpose This study aimed to investigate whether a disease site–specific, multi-institutional knowledge based-planning (KBP) model can improve the quality of intensity modulated radiation therapy treatment planning for patients enrolled in the head and neck NRG-HN001clinical trial and to establish a threshold of improvements of treatment plans submitted to the clinical trial. Methods and Materials Fifty treatment plans for patients enrolled in the NRG-HN001 clinical trial were used to build a KBP model; the model was then used to reoptimize 50 other plans. We compared the dosimetric parameters of the submitted and KBP reoptimized plans. We compared differences between KBP and submitted plans for single- and multi-institutional treatment plans. Results Mean values for the dose received by 95% of the planning target volume (PTV_6996) and for the maximum dose (D0.03cc) of PTV_6996 were 0.5 Gy and 2.1 Gy higher in KBP plans than in the submitted plans, respectively. Mean values for D0.03cc to the brain stem, spinal cord, optic nerve_R, optic nerve_L, and chiasm were 2.5 Gy, 1.9 Gy, 6.4 Gy, 6.6 Gy, and 5.7 Gy lower in the KBP plans than in the submitted plans. Mean values for D mean to parotid_R and parotid_L glands were 2.2 Gy and 3.8 Gy lower in KBP plans, respectively. In 33 out of 50 KBP plans, we observed improvements in sparing of at least 7 organs at risk (OARs) (brain stem, spinal cord, optic nerves (R & L), chiasm, and parotid glands [R & L]). A threshold of improvement of OARs sparing of 5% of the prescription dose was established for providing the quality assurance results back to the treating institution. Conclusions A disease site–specific, multi-institutional, clinical trial-based KBP model improved sparing of OARs in a large number of reoptimized plans submitted to the NRG-HN001 clinical trial, and the model is being used as an offline quality assurance tool .

Knowledge‐based radiation treatment planning: A data‐driven method survey

“…Between 2018 and 2020, most studies on traditional KBP methods have been based on a commercial KBP module rather than further development of earlier ML or statistical methods. 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 This is certainly not because traditional KBP methods have been fully explored, but presumably due to the wider availability of a commercial KBP module in clinical practice and increased interest in exploring DL methods owing to their recent success in achieving state‐of‐the‐art performance in many medical applications. In recent years, a wide array of research on developing new prediction models has transitioned from traditional KBP methods to DL KBP methods.…”

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

“…KBP has been used for retrospective review of treatment plan quality in head and neck [16,22,23], lung [13] and prostate cancer [24], and vertebral SABR [17]. In all cases, plans performed with KBP were shown to improve the consistency of treatment plan quality, and result in reduced doses to OARs.…”

“…In all cases, plans performed with KBP were shown to improve the consistency of treatment plan quality, and result in reduced doses to OARs. KBP real-time review processes have been developed for NRG-HN001, facilitated by the Imaging and Radiation Oncology Core [16], and in NRG-GY006 [10,26]. To our knowledge, this is the first report of prospective use of KBP for real-time review in clinical trial QA.…”

“…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].…”

“…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]. In the current work, we report the use of KBP in real-time QA for the FAS-TRACK II trial.…”