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Fiandra C, Zara S, Richetto V, Rossi L, Leonardi MC, Ferrari P, Marrocco M, Gino E, Cora S, Loi G, Rosica F, Ren Kaiser S, Verdolino E, Strigari L, Romeo N, Placidi L, Comi S, De Otto G, Roggio A, Di Dio A, Reversi L, Pierpaoli E, Infusino E, Coeli E, Licciardello T, Ciarmatori A, Caivano R, Poggiu A, Ciscognetti N, Ricardi U, Heijmen B. Multi-centre real-world validation of automated treatment planning for breast radiotherapy. Phys Med 2024; 123:103394. [PMID: 38852364 DOI: 10.1016/j.ejmp.2024.103394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/29/2024] [Accepted: 06/01/2024] [Indexed: 06/11/2024] Open
Abstract
PURPOSE To present the results of the first multi-centre real-world validation of autoplanning for whole breast irradiation after breast-sparing surgery, encompassing high complexity cases (e.g. with a boost or regional lymph nodes) and a wide range of clinical practices. METHODS The 24 participating centers each included 10 IMRT/VMAT/Tomotherapy patients, previously treated with a manually generated plan ('manplan'). There were no restrictions regarding case complexity, planning aims, plan evaluation parameters and criteria, fractionation, treatment planning system or treatment machine/technique. In addition to dosimetric comparisons of autoplans with manplans, blinded plan scoring/ranking was conducted by a clinician from the treating center. Autoplanning was performed using a single configuration for all patients in all centres. Deliverability was verified through measurements at delivery units. RESULTS Target dosimetry showed comparability, while reductions in OAR dose parameters were 21.4 % for heart Dmean, 16.7 % for ipsilateral lung Dmean, and 101.9 %, 45.5 %, and 35.7 % for contralateral breast D0.03cc, D5% and Dmean, respectively (all p < 0.001). Among the 240 patients included, the clinicians preferred the autoplan for 119 patients, with manplans preferred for 96 cases (p = 0.01). Per centre there were on average 5.0 ± 2.9 (1SD) patients with a preferred autoplan (range [0-10]), compared to 4.0 ± 2.7 with a preferred manplan ([0,9]). No differences were observed regarding deliverability. CONCLUSION The automation significantly reduced the hands-on planning workload compared to manual planning, while also achieving an overall superiority. However, fine-tuning of the autoplanning configuration prior to clinical implementation may be necessary in some centres to enhance clinicians' satisfaction with the generated autoplans.
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Affiliation(s)
- C Fiandra
- University of Turin, Department of Oncology, Turin, Italy.
| | - S Zara
- Tecnologie Avanzate, Turin, Italy
| | - V Richetto
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - L Rossi
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M C Leonardi
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - P Ferrari
- Department of Health Physics, Provincial Hospital of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano-Bozen, Italy
| | - M Marrocco
- Radiation Oncology, Campus Biomedico University, Rome, Italy
| | - E Gino
- SC Fisica Sanitaria AO Ordine Mauriziano di Torino, Turin, Italy
| | - S Cora
- U.O.C. Fisica Sanitaria, Ospedale "San Bortolo", AULSS8, Vicenza, Italy
| | - G Loi
- Department of Medical Physics, 'Maggiore della Carità' University Hospital, Novara, Italy
| | - F Rosica
- U.O.C. Fisica Sanitaria, ASL Teramo, Italy
| | - S Ren Kaiser
- S.C. Fisica Sanitaria, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | | | - L Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - N Romeo
- UOC Radioterapia. Azienda Sanitaria Provinciale di Messina. Ospedale "San Vincenzo", Taormina, Italy
| | - L Placidi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - S Comi
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - G De Otto
- S.C. Fisica Sanitaria Firenze-Empoli Azienda USL Toscana Centro, Italy
| | - A Roggio
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - A Di Dio
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - L Reversi
- Ospedali Riuniti di Ancona - Medical Physics Department, Ancona, Italy
| | - E Pierpaoli
- UOC Fisica Sanitaria, Area Vasta 5 Asur P.O. Mazzoni, Ascoli, Italy
| | - E Infusino
- Medical Physics Dept IRCCS Regina Elena National Cancer Institute, Rome
| | - E Coeli
- U.O.C. di RADIOTERAPIA Azienda ULSS 9 Scaligera del Veneto, Legnago (VR), Italy
| | - T Licciardello
- SC Fisica Sanitaria, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - A Ciarmatori
- UOC Fisica Medica e Alte Tecnologie, AST Pesaro Urbino, Pesaro, Italy
| | - R Caivano
- UOC di Radioterapia Oncologica e Fisica Sanitaria, IRCCS CROB Rionero in Vulture, Potenza, Italy
| | - A Poggiu
- SSD Fisica Sanitaria AOU Sassari, Italy
| | - N Ciscognetti
- ASL2 liguria - Dipartimento di diagnostic, SSD fisica sanitaria, Savona, Italy
| | - U Ricardi
- University of Turin, Department of Oncology, Turin, Italy
| | - B Heijmen
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Tang C, Liu B, Yuan J, He J, Xie R, Huang M, Niu S, Liu H. Dosimetric evaluation of different planning strategies for hypofractionated whole-breast irradiation technique. Phys Med Biol 2024; 69:115025. [PMID: 38670137 DOI: 10.1088/1361-6560/ad4445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 04/26/2024] [Indexed: 04/28/2024]
Abstract
Purpose.The dose hotspot areas in hypofractionated whole-breast irradiation (WBI) greatly increase the risk of acute skin toxicity because of the anatomical peculiarities of the breast. In this study, we presented several novel planning strategies that integrate multiple sub-planning target volumes (sub-PTVs), field secondary placement, and RapidPlan models for right-sided hypofractionated WBI.Methods.A total of 35 cases of WBI with a dose of 42.5 Gy for PTVs using tangential intensity-modulated radiotherapy (IMRT) were selected. Both PTVs were planned for simultaneous treatment using the original manual multiple sub-PTV plan (OMMP) and the original manual single-PTV plan (OMSP). The manual field secondary placement multiple sub-PTV plan (m-FSMP) with multiple objects on the original PTV and the manual field secondary placement single-objective plan (m-FSSP) were initially planned, which were distribution-based of V105 (volume receiving 105% of the prescription dose). In addition, two RapidPlan-based plans were developed, including the RapidPlan-based multiple sub-PTVs plan (r-FSMP) and the RapidPlan-based single-PTV plan (r-FSSP). Dosimetric parameters of the plans were compared, and V105 was evaluated using multivariate analysis to determine how it was related to the volume of PTV and the interval of lateral beam angles (ILBA).Results.The lowest mean V105 (5.64 ± 6.5%) of PTV was observed in m-FSMP compared to other manual plans. Upon validation, r-FSSP demonstrated superior dosimetric quality for OAR compared to the two other manual planning methods, except for V5(the volume of ipsilateral lung receiving 5 Gy) of the ipsilateral lung. While r-FSMP showed no significant difference (p = 0.06) compared to r-FSSP, it achieved the lowest V105 value (4.3 ± 4.5%), albeit with a slight increase in the dose to some OARs. Multivariate GEE linear regression showed that V105 is significantly correlated with target volume and ILBA.Conclusions.m-FSMP and r-FSMP can substantially enhance the homogeneity index (HI) and reduce V105, thereby minimizing the risk of acute skin toxicities, even though there may be a slight dose compromise for certain OARs.
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Affiliation(s)
- Chunbo Tang
- Department of Radiation Oncology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, People's Republic of China
- Jiangxi Clinical Research Center for Cancer, Ganzhou 341000, People's Republic of China
| | - Biaoshui Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Jun Yuan
- Department of Radiation Oncology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, People's Republic of China
- Jiangxi Clinical Research Center for Cancer, Ganzhou 341000, People's Republic of China
| | - Ji He
- School of Biomedical Engineering, Fourth Affiliated Hospital of Guangzhou, Guangzhou Medical University, Guangzhou 511495, People's Republic of China
| | - Ruilian Xie
- Jiangxi Clinical Research Center for Cancer, Ganzhou 341000, People's Republic of China
| | - Minfeng Huang
- First Clinical Medical College, Gannan Medical University, Ganzhou 341000, People's Republic of China
| | - Shanzhou Niu
- School of Mathematics and Computer Science, Gannan Normal University, Ganzhou 341000, People's Republic of China
- Ganzhou Key Laboratory of Computational Imaging , Gannan Normal University, Ganzhou 341000, People's Republic of China
| | - Hongdong Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
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Zaratim GRR, dos Reis RG, dos Santos MA, Yagi NA, Oliveira e Silva LF. Automated treatment planning for whole breast irradiation with individualized tangential IMRT fields. J Appl Clin Med Phys 2024; 25:e14361. [PMID: 38642406 PMCID: PMC11087165 DOI: 10.1002/acm2.14361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/04/2024] [Accepted: 04/01/2024] [Indexed: 04/22/2024] Open
Abstract
PURPOSES This study aimed to develop and validate algorithms for automating intensity modulated radiation therapy (IMRT) planning in breast cancer patients, with a focus on patient anatomical characteristics. MATERIAL AND METHODS We retrospectively selected 400 breast cancer patients without lymph node involvement for automated treatment planning. Automation was achieved using the Eclipse Scripting Application Programming Interface (ESAPI) integrated into the Eclipse Treatment Planning System. We employed three beam insertion geometries and three optimization strategies, resulting in 3600 plans, each delivering a 40.05 Gy dose in 15 fractions. Gantry angles in the tangent fields were selected based on a criterion involving the minimum intersection area between the Planning Target Volume (PTV) and the ipsilateral lung in the Beam's Eye View projection. ESAPI was also used to gather patient anatomical data, serving as input for Random Forest models to select the optimal plan. The Random Forest classification considered both beam insertion geometry and optimization strategy. Dosimetric data were evaluated in accordance with the Radiation Therapy Oncology Group (RTOG) 1005 protocol. RESULTS Overall, all approaches generated high-quality plans, with approximately 94% meeting the acceptable dose criteria for organs at risk and/or target coverage as defined by RTOG guidelines. Average automated plan generation time ranged from 6 min and 37 s to 9 min and 22 s, with the mean time increasing with additional fields. The Random Forest approach did not successfully enable automatic planning strategy selection. Instead, our automated planning system allows users to choose from the tested geometry and strategy options. CONCLUSIONS Although our attempt to correlate patient anatomical features with planning strategy using machine learning tools was unsuccessful, the resulting dosimetric outcomes proved satisfactory. Our algorithm consistently produced high-quality plans, offering significant time and efficiency advantages.
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Affiliation(s)
- Giulianne Rivelli Rodrigues Zaratim
- Department of Radiation OncologyCONFIAR RadiotherapyGoiâniaGoiásBrazil
- Department of Radiation OncologyUniversity Hospital of BrasiliaBrasiliaFederal DistrictBrazil
| | - Ricardo Gomes dos Reis
- Department of Radiation OncologyUniversity Hospital of BrasiliaBrasiliaFederal DistrictBrazil
| | | | - Nathalya Ala Yagi
- Department of Radiation OncologyCONFIAR RadiotherapyGoiâniaGoiásBrazil
- Department of Radiation OncologyUniversity Hospital of BrasiliaBrasiliaFederal DistrictBrazil
| | - Luis Felipe Oliveira e Silva
- Department of Radiation OncologyCONFIAR RadiotherapyGoiâniaGoiásBrazil
- Department of Radiation OncologyUniversity Hospital of BrasiliaBrasiliaFederal DistrictBrazil
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Castriconi R, Tudda A, Placidi L, Benecchi G, Cagni E, Dusi F, Ianiro A, Landoni V, Malatesta T, Mazzilli A, Meffe G, Oliviero C, Rambaldi Guidasci G, Scaggion A, Trojani V, Del Vecchio A, Fiorino C. Inter-institutional variability of knowledge-based plan prediction of left whole breast irradiation. Phys Med 2024; 120:103331. [PMID: 38484461 DOI: 10.1016/j.ejmp.2024.103331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/05/2024] [Accepted: 03/08/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE Within a multi-institutional project, we aimed to assess the transferability of knowledge-based (KB) plan prediction models in the case of whole breast irradiation (WBI) for left-side breast irradiation with tangential fields (TF). METHODS Eight institutions set KB models, following previously shared common criteria. Plan prediction performance was tested on 16 new patients (2 pts per centre) extracting dose-volume-histogram (DVH) prediction bands of heart, ipsilateral lung, contralateral lung and breast. The inter-institutional variability was quantified by the standard deviations (SDint) of predicted DVHs and mean-dose (Dmean). The transferability of models, for the heart and the ipsilateral lung, was evaluated by the range of geometric Principal Component (PC1) applicability of a model to test patients of the other 7 institutions. RESULTS SDint of the DVH was 1.8 % and 1.6 % for the ipsilateral lung and the heart, respectively (20 %-80 % dose range); concerning Dmean, SDint was 0.9 Gy and 0.6 Gy for the ipsilateral lung and the heart, respectively (<0.2 Gy for contralateral organs). Mean predicted doses ranged between 4.3 and 5.9 Gy for the ipsilateral lung and 1.1-2.3 Gy for the heart. PC1 analysis suggested no relevant differences among models, except for one centre showing a systematic larger sparing of the heart, concomitant to a worse PTV coverage, due to high priority in sparing the left anterior descending coronary artery. CONCLUSIONS Results showed high transferability among models and low inter-institutional variability of 2% for plan prediction. These findings encourage the building of benchmark models in the case of TF-WBI.
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Affiliation(s)
- Roberta Castriconi
- Medical Physics Dept, IRCCS San Raffaele Scientific Institute, Milano, Italy.
| | - Alessia Tudda
- Medical Physics Dept, IRCCS San Raffaele Scientific Institute, Milano, Italy; Università Statale di Milano, Milano, Italy
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanna Benecchi
- Medical Physics Dept, University Hospital of Parma AOUP, Parma, Italy
| | - Elisabetta Cagni
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Dusi
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Anna Ianiro
- IRCCS Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | - Valeria Landoni
- IRCCS Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | - Tiziana Malatesta
- UOC di Radioterapia Oncologica, Fatebenefratelli Isola Tiberina - Gemelli Isola, Roma, Italy
| | - Aldo Mazzilli
- Medical Physics Dept, University Hospital of Parma AOUP, Parma, Italy
| | - Guenda Meffe
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Valeria Trojani
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Claudio Fiorino
- Medical Physics Dept, IRCCS San Raffaele Scientific Institute, Milano, Italy
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Huang Y, Qin T, Yang M, Liu Z. Impact of ovary-sparing treatment planning on plan quality, treatment time and gamma passing rates in intensity-modulated radiotherapy for stage I/II cervical cancer. Medicine (Baltimore) 2023; 102:e36373. [PMID: 38115303 PMCID: PMC10727547 DOI: 10.1097/md.0000000000036373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND This study aimed to investigate the impact of ovary-sparing intensity-modulated radiotherapy (IMRT) on plan quality, treatment time, and gamma passing rates for stage I/II cervical cancer patients. METHODS Fifteen stage I/II cervical cancer patients were retrospectively enrolled, and a pair of clinically suitable IMRT plans were designed for each patient, with (Group A) and without (Group B) ovary-sparing. Plan factors affecting plan quality, treatment time, and gamma passing rates, including the number of segments, monitor units, percentage of small-area segments (field area < 20 cm2), and percentage of small-MU segments (MU < 10), were compared and statistically analyzed. Key plan quality indicators, including ovarian dose, target dose coverage (D98%, D95%, D50%, D2%), conformity index, and homogeneity index, were evaluated and statistically assessed. Treatment time and gamma passing rates collected by IBA MatriXX were also compared. RESULTS The median ovarian dose in Group A and Group B was 7.61 Gy (range 6.71-8.51 Gy) and 38.52 Gy (range 29.84-43.82 Gy), respectively. Except for monitor units, all other plan factors were significantly lower in Group A than in Group B (all P < .05). Correlation coefficients between plan factors, treatment time, and gamma passing rates that were statistically different were all negative. Both Groups of plans met the prescription requirement (D95% ≥ 45.00 Gy) for clinical treatment. D98% was smaller for Group A than for Group B (P < .05); D50% and D2% were larger for Group A than for Group B (P < .05, P < .05). Group A plans had worse conformity index and homogeneity index than Group B plans (P < .05, P < .05). Treatment time did not differ significantly (P > .05). Gamma passing rates in Group A were higher than in Group B with the criteria of 2%/3 mm (P < .05) and 3%/2 mm (P < .05). CONCLUSION Despite the slightly decreased quality of the treatment plans, the ovary-sparing IMRT plans exhibited several advantages including lower ovarian dose and plan complexity, improved gamma passing rates, and a negligible impact on treatment time.
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Affiliation(s)
- Yangyang Huang
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Tingting Qin
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Menglin Yang
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Zongwen Liu
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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Tudda A, Castriconi R, Benecchi G, Cagni E, Cicchetti A, Dusi F, Esposito PG, Guernieri M, Ianiro A, Landoni V, Mazzilli A, Moretti E, Oliviero C, Placidi L, Rambaldi Guidasci G, Rancati T, Scaggion A, Trojani V, Fiorino C. Knowledge-based multi-institution plan prediction of whole breast irradiation with tangential fields. Radiother Oncol 2022; 175:10-16. [PMID: 35868603 DOI: 10.1016/j.radonc.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To quantify inter-institute variability of Knowledge-Based (KB) models for right breast cancer patients treated with tangential fields whole breast irradiation (WBI). MATERIALS AND METHODS Ten institutions set KB models by using RapidPlan (Varian Inc.), following previously shared methodologies. Models were tested on 20 new patients from the same institutes, exporting DVH predictions of heart, ipsilateral lung, contralateral lung, and contralateral breast. Inter-institute variability was quantified by the inter-institute SDint of predicted DVHs/Dmean. Association between lung sparing vs PTV coverage strategy was also investigated. The transferability of models was evaluated by the overlap of each model's geometric Principal Component (PC1) when applied to the test patients of the other 9 institutes. RESULTS The overall inter-institute variability of DVH/Dmean ipsilateral lung dose prediction, was less than 2% (20%-80% dose range) and 0.55 Gy respectively (1SD) for a 40 Gy in 15 fraction schedule; it was < 0.2 Gy for other OARs. Institute 6 showed the lowest mean dose prediction value and no overlap between PTV and ipsilateral lung. Once excluded, the predicted ipsilateral lung Dmean was correlated with median PTV D99% (R2 = 0.78). PC1 values were always within the range of applicability (90th percentile) for 7 models: for 2 models they were outside in 1/18 cases. For the model of institute 6, it failed in 7/18 cases. The impact of inter-institute variability of dose calculation was tested and found to be almost negligible. CONCLUSIONS Results show limited inter-institute variability of plan prediction models translating in high inter-institute interchangeability, except for one of ten institutes. These results encourage future investigations in generating benchmarks for plan prediction incorporating inter-institute variability.
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Affiliation(s)
- Alessia Tudda
- Medical Physics Dept, San Raffaele Scientific Institute, Milano, Italy; Università Statale di Milano, Milano, Italy
| | | | | | - Elisabetta Cagni
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Francesca Dusi
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Marika Guernieri
- Department of Medical Physics, University Hospital, Udine, Italy
| | - Anna Ianiro
- Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | | | - Aldo Mazzilli
- Medical Physics Dept, University Hospital of Parma AOUP, Italy
| | - Eugenia Moretti
- Department of Medical Physics, University Hospital, Udine, Italy
| | | | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Rambaldi Guidasci
- Amethyst Radioterapia Italia, Medical Physics Department, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Valeria Trojani
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Claudio Fiorino
- Medical Physics Dept, San Raffaele Scientific Institute, Milano, Italy
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Esposito PG, Castriconi R, Mangili P, Broggi S, Fodor A, Pasetti M, Tudda A, Di Muzio NG, del Vecchio A, Fiorino C. Knowledge-based automatic plan optimization for left-sided whole breast tomotherapy. Phys Imaging Radiat Oncol 2022; 23:54-59. [PMID: 35814259 PMCID: PMC9256826 DOI: 10.1016/j.phro.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background/Purpose Tomotherapy may deliver high-quality whole breast irradiation at static angles. The aim of this study was to implement Knowledge-Based (KB) automatic planning for left-sided whole breast using this modality. Materials/Methods Virtual volumetric plans were associated to the dose distributions of 69 Tomotherapy (TT) clinical plans of previously treated patients, aiming to train a KB-model using a commercial tool completely implemented in our treatment planning system. An individually optimized template based on the resulting KB-model was generated for automatic plan optimization. Thirty patients of the training set and ten new patients were considered for internal/external validation. Fully-automatic plans (KB-TT) were generated and compared using the same geometry/number of fields of the corresponding clinical plans. Results KB-TT plans were successfully generated in 26/30 and 10/10 patients of the internal/external validation sets; for 4 patients whose original plans used only two fields, the manual insertion of one/two fields before running the automatic template was sufficient to obtain acceptable plans. Concerning internal validation, planning target volume V95%/D1%/dose distribution standard deviation improved by 0.9%/0.4Gy/0.2Gy (p < 0.05) against clinical plans; Organs at risk mean doses were also slightly improved (p < 0.05) by 0.07/0.4/0.2/0.01 Gy for left lung/heart/right breast/right lung respectively. Similarly satisfactory results were replicated in the external validation set. The resulting treatment duration was 8 ± 1 min, consistent with our clinical experience. The active planner time per patient was 5–10 minutes. Conclusion Automatic TT left-sided breast KB-plans are comparable to or slightly better than clinical plans and can be obtained with limited planner time. The approach is currently under clinical implementation.
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Evaluation of robustness in hybrid intensity-modulated radiation therapy plans generated by commercial software for automated breast planning. Sci Rep 2022; 12:1418. [PMID: 35082374 PMCID: PMC8791968 DOI: 10.1038/s41598-022-05538-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/13/2022] [Indexed: 12/27/2022] Open
Abstract
This study aimed to evaluate the robustness against geometric uncertainties in the hybrid intensity-modulated radiation therapy (IMRT) plans generated by commercially available software for automated breast planning (ABP). The ABP plans were compared with commonly used forward-planned field-in-field (FIF) technique plans. The planning computed tomography datasets of 20 patients who received left-sided breast-conserving surgery were used for both the ABP and FIF plans. Geometric uncertainties were simulated by shifting beam isocenters by 2, 3, 5, and 10 mm in the six directions: anterior/posterior, left/right, and superior/inferior. A total of 500 plans (20 patients and 25 scenarios, including the original plan) were created for each of the ABP and FIF plans. The homogeneity index of the target volume in the ABP plans was significantly better (p < 0.001) than the value in the FIF plans in the scenarios of shifting beam isocenters by 2, 3, and 5 mm. Mean heart dose and percentage volume of lungs receiving a dose more than 20 Gy were clinically acceptable in all scenarios. The hybrid IMRT plans generated by commercially available ABP software provided better robustness against geometric uncertainties than forward-planned FIF plans.
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Castriconi R, Esposito PG, Tudda A, Mangili P, Broggi S, Fodor A, Deantoni CL, Longobardi B, Pasetti M, Perna L, Del Vecchio A, Di Muzio NG, Fiorino C. Replacing Manual Planning of Whole Breast Irradiation With Knowledge-Based Automatic Optimization by Virtual Tangential-Fields Arc Therapy. Front Oncol 2021; 11:712423. [PMID: 34504790 PMCID: PMC8423088 DOI: 10.3389/fonc.2021.712423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To implement Knowledge Based (KB) automatic planning for right and left-sided whole breast treatment through a new volumetric technique (ViTAT, Virtual Tangential-fields Arc Therapy) mimicking conventional tangential fields (TF) irradiation. Materials and Method A total of 193 clinical plans delivering TF with wedged or field-in-field beams were selected to train two KB-models for right(R) and left(L) sided breast cancer patients using the RapidPlan (RP) tool implemented in the Varian Eclipse system. Then, a template for ViTAT optimization, incorporating individual KB-optimized constraints, was interactively fine-tuned. ViTAT plans consisted of four arcs (6 MV) with start/stop angles consistent with the TF geometry variability within our population; the delivery was completely blocked along the arcs, apart from the first and last 20° of rotation for each arc. Optimized fine-tuned KB templates for automatic plan optimization were generated. Validation tests were performed on 60 new patients equally divided in R and L breast treatment: KB automatic ViTAT-plans (KB-ViTAT) were compared against the original TF plans in terms of OARs/PTVs dose-volume parameters. Wilcoxon-tests were used to assess the statistically significant differences. Results KB models were successfully generated for both L and R sides. Overall, 1(3%) and 7(23%) out of 30 automatic KB-ViTAT plans were unacceptable compared to TF for R and L side, respectively. After the manual refinement of the start/stop angles, KB-ViTAT plans well fitted TF-performances for these patients as well. PTV coverage was comparable, while PTV D1% was improved with KB-ViTAT by R:0.4/L:0.2 Gy (p < 0.05); ipsilateral OARs Dmean were similar with a slight (i.e., few % volume) improvement/worsening in the 15–35 Gy/2–15 Gy range, respectively. KB-ViTAT better spared contralateral OARs: Dmean of contralateral OARs was 0.1 Gy lower (p < 0.05); integral dose was R:5%/L:8% lower (p < 0.05) than TF. The overall time for the automatic plan optimization and final dose calculation was 12 ± 2 minutes. Conclusions Fully automatic KB-optimization of ViTAT can efficiently replace manually optimized TF planning for whole breast irradiation. This approach was clinically implemented in our institute and may be suggested as a large-scale strategy for efficiently replacing manual planning with large sparing of time, elimination of inter-planner variability and of, seldomly occurring, sub-optimal manual plans.
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Affiliation(s)
| | | | - Alessia Tudda
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Paola Mangili
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Andrei Fodor
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | | | | | | | - Lucia Perna
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
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Comparison of volumetric modulated arc therapy and intensity-modulated radiotherapy for left-sided whole-breast irradiation using automated planning. Strahlenther Onkol 2021; 198:236-246. [PMID: 34351452 PMCID: PMC8863712 DOI: 10.1007/s00066-021-01817-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/01/2021] [Indexed: 11/23/2022]
Abstract
Background Published treatment technique comparisons for postoperative left-sided whole breast irradiation (WBI) with deep-inspiration breath-hold (DIBH) are scarce, small, and inconclusive. In this study, fully automated multi-criterial plan optimization, generating a single high-quality, Pareto-optimal plan per patient and treatment technique, was used to compare for a large patient cohort 1) intensity modulated radiotherapy (IMRT) with two tangential fields and 2) volumetric modulated arc therapy (VMAT) with two small tangential subarcs. Materials and methods Forty-eight randomly selected patients recently treated with DIBH and 16 × 2.66 Gy were included. The optimizer was configured for the clinical planning protocol. Comparisons between IMRT and VMAT included dosimetric plan parameters, estimated excess relative risks (ERR) for toxicities, delivery times, MUs, and deliverability accuracy at a linac. Results The automatically generated IMRT and VMAT plans applied in this study were similar or higher in quality than the manually generated clinical plans. For equal PTVin V95% (98.4 ± 0.9%), VMAT had significant advantages compared to IMRT regarding breast dose homogeneity and doses in heart and ipsilateral lung, at the cost of some minor deteriorations for contralateral breast (few cases with larger deteriorations) and lung. Conformality improved from 1.38 to 1.18 (p < 0.001). With VMAT, ERR for major coronary events and ipsilateral lung tumors were reduced by 3% (range: −1–12%) and 16% (range: −3–38%), respectively. MUs and delivery times were higher for VMAT. There were no statistical differences in γ passing rates. Conclusion For WBI in conservative therapy of left-sided breast patients treated with DIBH, VMAT with two tangential subarcs was generally dosimetrically superior to IMRT with two tangential static fields. Results need confirmation by robustness analyses.
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11
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Reduction of heart and lung normal tissue complication probability using automatic beam angle optimization and more generic optimization objectives for breast radiotherapy. Phys Imaging Radiat Oncol 2021; 18:48-50. [PMID: 34258407 PMCID: PMC8254193 DOI: 10.1016/j.phro.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/08/2021] [Accepted: 04/20/2021] [Indexed: 11/20/2022] Open
Abstract
During breast cancer radiotherapy, sparing of healthy tissue is desired. The effect of automatic beam angle optimization and generic dose fall-off objectives on dose and normal tissue complication probabilities was studied. In all patients, dose to lungs and heart showed a mean reduction of 0.4 Gy (range 0.1–1.3 Gy) and 0.2 Gy (range −0.2–0.7 Gy), respectively. These lower doses led to a statistically significant lower cumulative cardiac and lung cancer mortality risk. For smoking patients 40–45 years of age who continue to smoke, it would lead to a reduction from 3.2% ± 0.7% to 2.7% ± 0.6% (p < 0.001).
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12
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Thomsen MS, Berg M, Zimmermann S, Lutz CM, Makocki S, Jensen I, Hjelstuen MHB, Pensold S, Hasler MP, Jensen MB, Offersen BV. Dose constraints for whole breast radiation therapy based on the quality assessment of treatment plans in the randomised Danish breast cancer group (DBCG) HYPO trial. Clin Transl Radiat Oncol 2021; 28:118-123. [PMID: 33937532 PMCID: PMC8079332 DOI: 10.1016/j.ctro.2021.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/27/2021] [Accepted: 03/28/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Quality assessment of the treatment plans in the Danish Breast Cancer Group (DBCG) HYPO trial was carried out based on prospectively reported dosimetric parameters and evidence-based dose constraints for whole breast radiation therapy were derived. Materials and methods From 2009 to 2014, 1882 patients (pts) were randomised between 50 Gy/25fractions (fr) versus 40 Gy/15fr. Doses to CTVp_breast (V95%, V107%-V110%, Dmax, and in addition for 40 Gy plans V105%-V107%), ipsilateral lung (V20Gy/V17Gy), heart (V20Gy/V17Gy, V40Gy/V35Gy), and left anterior descending coronary artery (LADCA) (Dmax) and use of respiratory gated technique were prospectively reported to the DBCG database. After end of accrual, these dosimetric parameters from all plans in the trial were compared to the pre-specified treatment constraints. Results In total, 1854 pts from eight radiation therapy (RT) centres in three countries were treated. No statistically significant differences were found between the results for 40 Gy and 50 Gy plans, except for CTVp_breast hot-spot volume (V107%-V110%). Of the 40 Gy pts, 90% with CTVp_breast > 600 mL and 95% with CTVp_breast ≤ 600 mL had a CTVp_breast hot-spot volume (V105%-V107%) <2%. In 95% of the 50 Gy plans, the CTVp_breast absolute hot-spot volume (V107%-V110%) was <0.5 mL and 1.7 mL for CTVp_breast ≤ 600 mL and > 600 mL, respectively. Compliance was >99% for both heart and lung constraints. Largest deviation from protocol constraints was found for the volume of CTVp_breast covered with 95% of the prescription dose or more (V95%). The CTV dose coverage (V95%) was >94.3% in 95% of the right-sided pts, whereas the figures for 95% of the left-sided pts treated with and without respiratory gating were 93.2% and 88.8%, respectively. Conclusion A high degree of compliance with protocol dose constraints was found for treatment plans in the DBCG HYPO trial. New constraints for dose to organs at risk and high-dose volumes in the breast are suggested for breast-only RT planning.
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Affiliation(s)
- M S Thomsen
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - M Berg
- Department of Medical Physics, Lillebaelt Hospital, Vejle, Denmark
| | - S Zimmermann
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - C M Lutz
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - S Makocki
- Dept of Radiation Oncology and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - I Jensen
- Department of Medical Physics, Aalborg University Hospital, Aalborg, Denmark
| | - M H B Hjelstuen
- Department of Radiotherapy, Stavanger University Hospital, Stavanger, Norway
| | - S Pensold
- Praxis for Radiotherapy, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - M P Hasler
- Department of Oncology, Sørlandet Hospital, Kristiansand, Norway
| | - M-B Jensen
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - B V Offersen
- Department of Experimental Clinical Oncology and Department of Oncology, Aarhus University Hospital, Denmark
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Esposito PG, Castriconi R, Mangili P, Fodor A, Pasetti M, Di Muzio NG, Del Vecchio A, Fiorino C. Virtual Tangential-fields Arc Therapy (ViTAT) for whole breast irradiation: Technique optimization and validation. Phys Med 2020; 77:160-168. [PMID: 32866777 DOI: 10.1016/j.ejmp.2020.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To test the performances of a volumetric arc technique named ViTAT (Virtual Tangential-fields Arc Therapy) mimicking tangential field irradiation for whole breast radiotherapy. METHODS ViTAT plans consisted in 4 arcs whose starting/ending position were established based on gantry angle distribution of clinical plans for right and left-breast. The arcs were completely blocked excluding the first and last 20°. Different virtual bolus densities and thicknesses were preliminarily evaluated to obtain the best plan performances. For 40 patients with tumor laterality equally divided between right and left sides, ViTAT plans were optimized considering the clinical DVHs for OARs (resulting from tangential field manual planning) to constrain them: ViTAT plans were compared with the clinical tangential-fields in terms of DVH parameters for both PTV and OARs. RESULTS Distal angle values were suggested in the ranges [220°,240°] for the right-breast and [115°,135°] for the left-breast cases; medial angles were [60°,40°] for the right side and [295°,315°] for the left side, limiting the risk of collision. The optimal virtual bolus had -500 HU density and 1.5 cm thickness. ViTAT plans generated dose distributions very similar to the tangential-field plans, with significantly improved PTV homogeneity. The mean doses of ipsilateral OARs were comparable between the two techniques with minor increase of the low-dose spread in the range 2-15 Gy (few % volume); contralateral OARs were slightly better spared with ViTAT. CONCLUSION ViTAT dose distributions were similar to tangential-fields. ViTAT should allow automatic plan optimization by developing knowledge-based DVH prediction models of patients treated with tangential-fields.
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Affiliation(s)
| | - Roberta Castriconi
- Medical Physics, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Paola Mangili
- Medical Physics, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Andrei Fodor
- Radiotherapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Marcella Pasetti
- Radiotherapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Nadia G Di Muzio
- Radiotherapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | | | - Claudio Fiorino
- Medical Physics, San Raffaele Hospital Scientific Institute, Milan, Italy.
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14
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van Duren-Koopman MJ, Tol JP, Dahele M, Bucko E, Meijnen P, Slotman BJ, Verbakel WF. Personalized automated treatment planning for breast plus locoregional lymph nodes using Hybrid RapidArc. Pract Radiat Oncol 2018; 8:332-341. [DOI: 10.1016/j.prro.2018.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/19/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
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