Class solutions for SABR-VMAT for high-risk prostate cancer with and without elective nodal irradiation

Osman, Sarah; Jeevanandam, Prakash; Kanakavelu, Nithya; Irvine, Denise M.; Lyons, C.; Jain, Suneil; Hounsell, Alan R.; McGarry, Conor K.

doi:10.1186/s13014-016-0730-7

Cited by 10 publications

(9 citation statements)

References 29 publications

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“…As reported by Hazell et al, better OAR sparing was obtained with slightly compromising target coverage relative to the manual plans due to lack of the postoptimization. 8 The concept of KBP can be broad, including early attempts of using class solutions, [19][20][21] applying template-based planning objectives, 22,23 and model-based predictive planning objectives. 10,12,13 The model-based KBP builds a model that is trained by prior clinically optimal plans from a specific treatment site to predict patient-specific achievable planning objectives.…”

Section: Discussionmentioning

confidence: 99%

Three IMRT advanced planning tools: A multi‐institutional side‐by‐side comparison

Yang

Donaghue

et al. 2019

J Applied Clin Med Phys

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Purpose: To assess three advanced radiation therapy treatment planning tools on the intensity-modulated radiation therapy (IMRT) quality and consistency when compared to the clinically approved plans, referred as manual plans, which were planned without using any of these advanced planning tools.Materials and Methods: Three advanced radiation therapy treatment planning tools, including auto-planning, knowledge-based planning, and multiple criteria optimization, were assessed on 20 previously treated clinical cases. Three institutions participated in this study, each with expertise in one of these tools. The twenty cases were retrospectively selected from Cleveland Clinic, including five head-and-neck (HN) cases, five brain cases, five prostate with pelvic lymph nodes cases, and five spine cases. A set of general planning objectives and organs-at-risk (OAR) dose constraints for each disease site from Cleveland Clinic was shared with other two institutions. A total of 60 IMRT research plans (20 from each institution) were designed with the same beam configuration as in the respective manual plans. For each disease site, detailed isodoseline distributions and dose volume histograms for a randomly selected representative case were compared among the three research plans and manual plan. In addition, dosimetric endpoints of five cases for each site were compared.Results: Compared to the manual plans, the research plans using advanced tools showed substantial improvement for the HN patient cases, including the maximum dose to the spinal cord and brainstem and mean dose to the parotid glands. For the brain, prostate, and spine cases, the four types of plans were comparable based on dosimetric endpoint comparisons. Conclusion: With minimal planner interventions, advanced treatment planning tools are clinically useful, producing a plan quality similarly to or better than manual plans, improving plan consistency. For difficult cases such as HN cancer, advanced planning tools can further reduce radiation doses to numerous OARs while delivering adequate dose to the tumor targets. K E Y W O R D S auto-planning, knowledge-based planning, multiple criteria optimization ---

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Section: Discussionmentioning

confidence: 99%

Three IMRT advanced planning tools: A multi‐institutional side‐by‐side comparison

Yang

Donaghue

et al. 2019

J Applied Clin Med Phys

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“…Plans were generated following our previously reported class solution [10], and employed a single 300° partial VMAT arc (210° -150°), delivered using a 10 MV flattening filter free photon beam with a maximum dose-rate of 2400MU/min. For one patient (Patient 3) the class solution could not be applied due to the presence of a right hip prosthesis, therefore two 215° partial arcs (335° -180°) were used instead.…”

Section: Treatment Planningmentioning

confidence: 99%

Efficacy of a rectal spacer with prostate SABR—first UK experience

King¹,

Osman

Fairmichael

et al. 2018

The British Journal of Radiology

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“…When the mandatory OARs constraints were not met, the prescribed dose to the DIL was incrementally dropped by 2.5 Gy increments to 47.5 Gy and 45 Gy as the lowest boost dose level. Two full VMAT arcs of 10 MV flattening-filter-free photon beam with a maximum dose rate of 2400 MU/min were used [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

Simultaneous integrated boost (SIB) to dominant intra-prostatic lesions during extreme hypofractionation for prostate cancer: the impact of rectal spacers

et al. 2022

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Purpose Boosting dominant intra-prostatic lesions (DILs) has the potential to increase the therapeutic ratio in prostate cancer radiotherapy. In this study, employing 5-fraction stereotactic ablative radiotherapy (SABR) volumetric modulated arc therapy (VMAT) to deliver 40 Gy to the prostate clinical target volume (CTV) while boosting the DIL up to 50 Gy was evaluated for patients before and after rectal spacer insertion. Materials and methods 24 Computed Tomography (CT) scans of 12 prostate cancer patients with unfavourable intermediate or high risk prostate cancer were employed in this study. At least two treatment plans were generated for each patient to compare pre- and post-spacer insertion plans. Plans were evaluated for target coverage, organs-at-risk doses, and the achievable boost dose level. Results The CTV coverage was significantly better in plans with a spacer, V40Gy 98.4% versus 97.0% (p = 0.012). Using spacers significantly reduced rectal dose in all 12 patients in this study. It was possible to boost DIL to 50 Gy to without violating dose constraints in 6 of 12 patients and to 47.5 Gy in 3 patients post-spacer insertion. For 3 patients (25%) it was not possible to boost DIL above 45 Gy even with a spacer in situ. Without a spacer, for 6 patient (50%) clinically acceptable plan were only achieved when the DIL dose was lowered to 45 Gy. In five of these 6 patients the dose limiting structure was the urethra (urethra planning risk volume V45Gy [cc] ≤ 0.1 cc constraint). Conclusions Clinically acceptable plans for 5 fraction SABR, 40 Gy to the prostate CTV, with a SIB to DIL (45–50 Gy) were achieved. The boost dose achieved was DIL location dependent and primarily affected by DIL’s proximity to the urethra. Compared to plans before spacer insertion, higher DIL dose were achieved with spacer in situ for 25% of the patients. Moreover, significant reduction in rectal dose and better target coverage were also achieved for all patients with spacers in situ.

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Class solutions for SABR-VMAT for high-risk prostate cancer with and without elective nodal irradiation

Cited by 10 publications

References 29 publications

Three IMRT advanced planning tools: A multi‐institutional side‐by‐side comparison

Three IMRT advanced planning tools: A multi‐institutional side‐by‐side comparison

Efficacy of a rectal spacer with prostate SABR—first UK experience

Simultaneous integrated boost (SIB) to dominant intra-prostatic lesions during extreme hypofractionation for prostate cancer: the impact of rectal spacers

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