Design and validation of an automated radiation therapy treatment planning approach for locally advanced lung cancer

Pogue, Joel A.; Cárdenas, Carlos; Harms, Joseph; Soike, M.; Kole, Adam J.; Schneider, Craig S.; Veale, Christopher; Popple, Richard A.; Belliveau, Jean-Guy; McDonald, Andrew M.; Stanley, Dennis N.

doi:10.1101/2022.09.30.22280584

Cited by 3 publications

(2 citation statements)

References 32 publications

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“…Two board certified radiation oncologists specializing in accelerated partial breast treatment qualitatively evaluated all twenty automatically generated Ethos validation cohort plans according to a previously-utilized in-house grading scheme, which is outlined in Table 3 (32). To avoid scoring bias, the physicians were not shown the Ethos optimization template before evaluation; in addition, the physicists did not provide feedback or respond to physicians during evaluation, nor were the physicians aware of the cardiac-sparing emphasis of this study.…”

Section: Physician Reviewmentioning

confidence: 99%

Leveraging intelligent optimization for automated, cardiac-sparing accelerated partial breast treatment planning

et al. 2023

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BackgroundAccelerated partial breast irradiation (APBI) yields similar rates of recurrence and cosmetic outcomes as compared to whole breast radiation therapy (RT) when patients and treatment techniques are appropriately selected. APBI combined with stereotactic body radiation therapy (SBRT) is a promising technique for precisely delivering high levels of radiation while avoiding uninvolved breast tissue. Here we investigate the feasibility of automatically generating high quality APBI plans in the Ethos adaptive workspace with a specific emphasis on sparing the heart.MethodsNine patients (10 target volumes) were utilized to iteratively tune an Ethos APBI planning template for automatic plan generation. Twenty patients previously treated on a TrueBeam Edge accelerator were then automatically replanned using this template without manual intervention or reoptimization. The unbiased validation cohort Ethos plans were benchmarked via adherence to planning objectives, a comparison of DVH and quality indices against the clinical Edge plans, and qualitative reviews by two board-certified radiation oncologists.Results85% (17/20) of automated validation cohort plans met all planning objectives; three plans did not achieve the contralateral lung V1.5Gy objective, but all other objectives were achieved. Compared to the Eclipse generated plans, the proposed Ethos template generated plans with greater evaluation planning target volume (PTV_Eval) V100% coverage (p = 0.01), significantly decreased heart V1.5Gy (p< 0.001), and increased contralateral breast V5Gy, skin D0.01cc, and RTOG conformity index (p = 0.03, p = 0.03, and p = 0.01, respectively). However, only the reduction in heart dose was significant after correcting for multiple testing. Physicist-selected plans were deemed clinically acceptable without modification for 75% and 90% of plans by physicians A and B, respectively. Physicians A and B scored at least one automatically generated plan as clinically acceptable for 100% and 95% of planning intents, respectively.ConclusionsStandard left- and right-sided planning templates automatically generated APBI plans of comparable quality to manually generated plans treated on a stereotactic linear accelerator, with a significant reduction in heart dose compared to Eclipse generated plans. The methods presented in this work elucidate an approach for generating automated, cardiac-sparing APBI treatment plans for daily adaptive RT with high efficiency.

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Section: Physician Reviewmentioning

confidence: 99%

Leveraging intelligent optimization for automated, cardiac-sparing accelerated partial breast treatment planning

et al. 2023

Self Cite

View full text Add to dashboard Cite

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“…Two board certified radiation oncologists specializing in accelerated partial breast treatment qualitatively evaluated all twenty automatically generated Ethos validation cohort plans according to a previously-utilized in-house grading scheme, which is outlined in Table 3 [40]. To avoid scoring bias, the physicians were not shown the Ethos optimization template before evaluation; in addition, the physicists did not provide feedback or respond to physicians during evaluation, nor were the physicians aware of the cardiac-sparing emphasis of this study.…”

Section: Physician Reviewmentioning

confidence: 99%

Leveraging intelligent optimization for automated, cardiac-sparing accelerated partial breast treatment planning

Pogue

Cárdenas

Cao

et al. 2022

Preprint

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Background: Accelerated partial breast irradiation (APBI) yields similar rates of recurrence and cosmetic outcomes as compared to whole breast radiation therapy (RT) when patients and treatment techniques are appropriately selected. APBI combined with stereotactic body radiation therapy (SBRT) is a promising technique for precisely delivering high levels of radiation while avoiding uninvolved breast tissue. Here we investigate the feasibility of automatically generating high quality APBI plans in the Ethos adaptive workspace with a specific emphasis on sparing the heart. Methods: Nine patients (10 target volumes) were utilized to iteratively tune an Ethos APBI planning template for automatic plan generation. Twenty patients previously treated on a TrueBeam Edge accelerator were then automatically replanned using this template without manual intervention or reoptimization. The unbiased validation cohort Ethos plans were benchmarked via adherence to planning objectives, a comparison of DVH and quality indices against the clinical Edge plans, and qualitative reviews by two board-certified radiation oncologists. Results: 85% (17/20) of automated validation cohort plans met all planning objectives; three plans did not achieve the contralateral lung V150cGy objective, but all other objectives were achieved. Compared to the Eclipse generated plans, the proposed Ethos template generated plans with greater evaluation planning target volume (PTV_Eval) V100% coverage (p = 0.01), significantly decreased heart V1500cGy (p < 0.001), and increased contralateral breast V500cGy, skin D0.01cc, and RTOG conformity index (p = 0.03, p = 0.03, and p = 0.01, respectively). However, only the reduction in heart dose was significant after correcting for multiple testing. Physicist-selected plans were deemed clinically acceptable without modification for 75% and 90% of plans by physicians A and B, respectively. Physicians A and B scored at least one automatically generated plan as clinically acceptable for 100% and 95% of planning intents, respectively. Conclusions: Standard left- and right-sided planning templates automatically generated APBI plans of comparable quality to manually generated plans treated on a stereotactic linear accelerator, with a significant reduction in heart dose compared to Eclipse generated plans. The methods presented in this work elucidate an approach for generating automated, cardiac-sparing APBI treatment plans for daily adaptive RT with high efficiency.

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Knowledge-based adaptive planning quality assurance using dosimetric indicators for stereotactic adaptive radiotherapy for pancreatic cancer

Forghani¹,

Ginn²,

Schiff³

et al. 2023

Radiotherapy and Oncology

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Design and validation of an automated radiation therapy treatment planning approach for locally advanced lung cancer

Cited by 3 publications

References 32 publications

Leveraging intelligent optimization for automated, cardiac-sparing accelerated partial breast treatment planning

Leveraging intelligent optimization for automated, cardiac-sparing accelerated partial breast treatment planning

Leveraging intelligent optimization for automated, cardiac-sparing accelerated partial breast treatment planning

Knowledge-based adaptive planning quality assurance using dosimetric indicators for stereotactic adaptive radiotherapy for pancreatic cancer

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