Treatment planning evaluation and optimization should be biologically and not dose/volume based

Deasy, Joseph O.; Mayo, Charles S.; Orton, Colin G.

doi:10.1118/1.4916670

Cited by 22 publications

(14 citation statements)

References 16 publications

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“…It was further observed that the MIP solver was not even able to find nontrivial feasible solutions of the DVM within 3 min for all patients; this is consistent with the results in Ref. . (We observed similar patterns when varying the random seed in the MIP solver Gurobi.…”

Section: Conclusion and Future Researchsupporting

confidence: 90%

“…Because of the difficulty in estimating the values of their parameters (particularly for TCP), the absolute values are rather uncertain and not a factual representation of the treatment effect. To move from using DIs for evaluating dose plans to using radiobiological measures as the primary evaluation criteria, more research is needed …”

Section: Discussionmentioning

confidence: 99%

“…The calculated TCP values should thus not be seen as an exact representation of the treatment effect, but rather as a means for comparing dose plans. (The use of TCP has been discussed and there is both a need for better estimates of parameter values and for more clinical studies on the correlation with the treatment outcome. )…”

Section: Methodsmentioning

confidence: 99%

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An extended dose–volume model in high dose‐rate brachytherapy – Using mean‐tail‐dose to reduce tumor underdosage

2019

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PurposeHigh dose–rate brachytherapy is a method of radiotherapy for cancer treatment in which the radiation source is placed within the body. In addition to give a high enough dose to a tumor, it is also important to spare nearby healthy organs [organs at risk (OAR)]. Dose plans are commonly evaluated using the so‐called dosimetric indices; for the tumor, the portion of the structure that receives a sufficiently high dose is calculated, while for OAR it is instead the portion of the structure that receives a sufficiently low dose that is of interest. Models that include dosimetric indices are referred to as dose–volume models (DVMs) and have received much interest recently. Such models do not take the dose to the coldest (least irradiated) volume of the tumor into account, which is a distinct weakness since research indicates that the treatment effect can be largely impaired by tumor underdosage even to small volumes. Therefore, our aim is to extend a DVM to also consider the dose to the coldest volume.MethodsAn improved DVM for dose planning is proposed. In addition to optimizing with respect to dosimetric indices, this model also takes mean dose to the coldest volume of the tumor into account.ResultsOur extended model has been evaluated against a standard DVM in ten prostate geometries. Our results show that the dose to the coldest volume could be increased, while also computing times for the dose planning were improved.ConclusionWhile the proposed model yields dose plans similar to other models in most aspects, it fulfils its purpose of increasing the dose to cold tumor volumes. An additional benefit is shorter solution times, and especially for clinically relevant times (of minutes) we show major improvements in tumour dosimetric indices.

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Section: Conclusion and Future Researchsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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An extended dose–volume model in high dose‐rate brachytherapy – Using mean‐tail‐dose to reduce tumor underdosage

2019

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“…For some parameters there are also individual variations to consider, making it even more difficult to get accurate results from TCP models. In [29] and [28] these uncertainties and difficulties with the use of TCP are discussed.…”

Section: Radiobiological Conceptsmentioning

confidence: 99%

Mathematical Modelling of Dose Planning in High Dose-Rate Brachytherapy

Morén

2019

Linköping Studies in Science and Technology. Licentiate Thesis

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“…Although a whole replacement of standard DVH-based metrics should not be recommended, the efforts may be addressed in order to validate outcome prediction models, overcoming the traditional evaluation metrics. (20)(21)(22)(23) Radiobiological data and response parameters -such as generalized equivalent uniform dose (gEUD), (24,25) tumor control probability (TCP), (26)(27)(28) or normal tissue complication probability (NTCP) (29)(30)(31)(32)(33)(34)(35) -can be obtained from DVH information. Hence, radiobiological metrics can be incorporated into individualized pretreatment QA process.…”

Section: Introductionmentioning

confidence: 99%

Assessment of radiobiological metrics applied to patient‐specific QA process of VMAT prostate treatments

Clemente-Gutiérrez

Perez-Vara

Clavo-Herranz

et al. 2016

J Applied Clin Med Phys

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VMAT is a powerful technique to deliver hypofractionated prostate treatments. The lack of correlations between usual 2D pretreatment QA results and the clinical impact of possible mistakes has allowed the development of 3D verification systems. Dose determination on patient anatomy has provided clinical predictive capability to patient-specific QA process. Dose-volume metrics, as evaluation criteria, should be replaced or complemented by radiobiological indices. These metrics can be incorporated into individualized QA extracting the information for response parameters (gEUD, TCP, NTCP) from DVHs. The aim of this study is to assess the role of two 3D verification systems dealing with radiobiological metrics applied to a prostate VMAT QA program. Radiobiological calculations were performed for AAPM TG-166 test cases. Maximum differences were 9.3% for gEUD, -1.3% for TCP, and 5.3% for NTCP calculations. Gamma tests and DVH-based comparisons were carried out for both systems in order to assess their performance in 3D dose determination for prostate treatments (high-, intermediate-, and low-risk, as well as prostate bed patients). Mean gamma passing rates for all structures were better than 92.0% and 99.1% for both 2%/2 mm and 3%/3 mm criteria. Maximum discrepancies were (2.4% ± 0.8%) and (6.2% ± 1.3%) for targets and normal tissues, respectively. Values for gEUD, TCP, and NTCP were extracted from TPS and compared to the results obtained with the two systems. Three models were used for TCP calculations (Poisson, sigmoidal, and Niemierko) and two models for NTCP determinations (LKB and Niemierko). The maximum mean difference for gEUD calculations was (4.7% ± 1.3%); for TCP, the maximum discrepancy was (-2.4% ± 1.1%); and NTCP comparisons led to a maximum deviation of (1.5% ± 0.5%). The potential usefulness of biological metrics in patient-specific QA has been explored. Both systems have been successfully assessed as potential tools for evaluating the clinical outcome of a radiotherapy treatment in the scope of pretreatment QA.

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Treatment planning evaluation and optimization should be biologically and not dose/volume based

Cited by 22 publications

References 16 publications

An extended dose–volume model in high dose‐rate brachytherapy – Using mean‐tail‐dose to reduce tumor underdosage

An extended dose–volume model in high dose‐rate brachytherapy – Using mean‐tail‐dose to reduce tumor underdosage

Mathematical Modelling of Dose Planning in High Dose-Rate Brachytherapy

Assessment of radiobiological metrics applied to patient‐specific QA process of VMAT prostate treatments

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