Exploration of clinical preferences in treatment planning of radiotherapy for prostate cancer using Pareto fronts and clinical grading analysis

Abstract

Introduction: Radiotherapy treatment planning is a multi-criteria problem. Any optimization of the process produces a set of mathematically optimal solutions. These optimal plans are considered mathematically equal, but they differ in terms of the trade-offs involved. Since the various objectives are conflicting, the choice of the best plan for treatment is dependent on the preferences of the radiation oncologists or the medical physicists (decision makers).We defined a clinically relevant area on a prostate Pareto front which better represented clinical preferences and determined if there were differences among radiation oncologists and medical physicists. Methods and materials: Pareto fronts of five localized prostate cancer patients were used to analyze and visualize the trade-off between the rectum sparing and the PTV under-dosage. Clinical preferences were evaluated with Clinical Grading Analysis by asking nine radiation oncologists and ten medical physicists to rate pairs of plans presented side by side. A choice of the optimal plan on the Pareto front was made by all decision makers. Results:The plans in the central region of the Pareto front (1-4% PTV under-dosage) received the best evaluations. Radiation oncologists preferred the organ at risk (OAR) sparing region (2.5-4% PTV under-dosage) while medical physicists preferred better PTV coverage (1-2.5% PTV under-dosage). When the Pareto fronts were additionally presented to the decisions makers they systematically chose the plan in the trade-off region (0.5-1% PTV under-dosage). Conclusion:We determined a specific region on the Pareto front preferred by the radiation oncologists and medical physicists and found a difference between them.

Comparative Study of Eclipse and RayStation Multi-Criteria Optimization-Based Prostate Radiotherapy Treatment Planning Quality

“…According to a recent systematic review and meta-analysis, patients who receive the prostate RT have 21.9% and 31.9% chances of having acute gastrointestinal and genitourinary toxicities, and 16.2% and 28.0% for the late toxicities, respectively [ 42 ]. In our study, the OAR, bladder was not selected as the trade-off criterion according to similar studies on evaluation of MCO function for the prostate RT planning [ 23 , 25 , 39 ]. This arrangement facilitated better illustration of the trade-offs between the PTV and rectum doses on the two-dimensional Pareto surface.…”

Validation of automated post-adjustments of HDR prostate brachytherapy treatment plans by quantitative measures and oncologist observer study

“…Maree et al ( 18 ) showed that their observers judged the treatment plans on "volumes with dose higher than 200%, the activation of dwell positions near the OARs, and the location of areas where the target was not covered" in addition to the DVH parameters. Kyroudi et al ( 16 ) used an observer study to find the optimal part of the Pareto front for EBRT prostate cancer treatments, showing that the observers preferred treatment plans with some PTV under-dosage, since these spared the rectum.…”