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

Abstract

Introduction Quality assurance (QA) of treatment plans in clinical trials improves protocol compliance and patient outcomes. Retrospective use of knowledge-based-planning (KBP) in clinical trials has demonstrated improved treatment plan quality and consistency. We report the results of prospective use of KBP for real-time QA of treatment plan quality in the TROG 15.03 FASTRACK II trial, which evaluates efficacy of stereotactic ablative body radiotherapy (SABR) for kidney cancer. Methods A KBP model was generated based on single institution data. For each patient in the KBP phase (open to the last 31 patients in the trial), the treating centre submitted treatment plans 7 days prior to treatment. A treatment plan was created by using the KBP model, which was compared with the submitted plan for each organ-at-risk (OAR) dose constraint. A report comparing each plan for each OAR constraint was provided to the submitting centre within 24 h of receiving the plan. The centre could then modify the plan based on the KBP report, or continue with the existing plan. Results Real-time feedback using KBP was provided in 24/31 cases. Consistent plan quality was in general achieved between KBP and the submitted plan. KBP review resulted in replan and improvement of OAR dosimetry in two patients. All centres indicated that the feedback was a useful QA check of their treatment plan. Conclusion KBP for real-time treatment plan review was feasible for 24/31 cases, and demonstrated ability to improve treatment plan quality in two cases. Challenges include integration of KBP feedback into clinical timelines, interpretation of KBP results with respect to clinical trade-offs, and determination of appropriate plan quality improvement criteria.

Evaluating the utility of knowledge-based planning for clinical trials using the TROG 08.03 post prostatectomy radiation therapy planning data

“…They were able to provide real time feedback for 77% of their cases with replan and improved OAR doses for 2 cases. All centres reported that the QA check for their treatment plan was useful, despite timeline challenges [20] . It must be acknowledged that not all planning systems are the same and therefore the predicted DVHs may not be achievable on a different planning systems, however they would provide a guide for plan improvement.…”

“…There have been an increasing number of publications reviewing the role of KBP to improve the plan consistency, the efficiency of planning and for treatment plan QA [9] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] . The TROG 08.03 clinical trial dataset provided an opportunity where plans, created in multiple treatment centres and having undergone centralised QA could be replanned using a KBP model and compared to the original treatment plan (OTP).…”

Can the use of knowledge-based planning systems improve stereotactic radiotherapy planning? A systematic review

“…This provided timely assurance that submitted trial plans were of sufficient quality and, in some cases, highlighted that improvement may be possible. 39…”

Why quality assurance is necessary in gynecologic radiation oncology

“…In another example, machine learning was applied in a prospective trial of stereotactic radiotherapy for kidney cancer, whereby a knowledge-based planning (KBP) model was developed using the dose and anatomy information from existing RT plans to provide an estimate of an optimal dose distribution in new patients. 29 Participating centers submitted radiotherapy plans prior to treatment and an independent plan was generated by the KBP system. These were then compared in terms of OAR dose constraint and target volume objectives.…”