Personalized automated treatment planning for breast plus locoregional lymph nodes using Hybrid RapidArc

Duren-Koopman, Mariët J van; Tol, Jim P.; Dahele, Max; Bućko, Ewa; Meijnen, Philip; Slotman, Ben J.; Verbakel, Wilko F.A.R.

doi:10.1016/j.prro.2018.03.008

Cited by 33 publications

(34 citation statements)

References 18 publications

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“…Probably, this is not due to different delineation of organs at risks, since similar guidelines were used as in other studies. One possible explanation may be that all plans in the current study were constructed by an experienced dosimetrist, which may indicate need for standardization of plan optimization, or possibly automation in generating plans [26,27].…”

Section: Discussionmentioning

confidence: 99%

Integration of biological factors in the treatment plan evaluation in breast cancer radiotherapy

Svensson

Lundstedt

Hällje

et al. 2019

Physics and Imaging in Radiation Oncology

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A B S T R A C TBackground/purpose: Tumor biology and patient smoking status have clear effects on the benefit of breast radiotherapy. This study developed treatment evaluation strategies that integrated dosimetry, tumor aggressiveness and smoking status for patients undergoing hypo-fractionated whole breast irradiation with simultaneous integrated boost. Materials/methods: The evaluation method Plan Quality Metrics (PQM) was adapted for breast cancer. Radiotherapy (RT) benefit was assessed for three levels of tumor aggressiveness; RT risk was estimated using mean dose to organs at risk and published Excess Relative Risk per Gy data for lung cancer and cardiac mortality for smokers and non-smokers. Risk for contralateral breast cancer was also evaluated. PQM and benefit/risk was applied to four patient groups (n = 10 each). Plans using 3D conformal radiotherapy (3DCRT), 3DCRT plus intensity-modulated radiation therapy (IMRT), 3DCRT plus volumetric modulated arc therapy (VMAT) and VMAT were evaluated for each patient. Results: 3DCRT-IMRT hybrid planning resulted in higher PQM score (median 87.0 vs. 3DCRT 82.4, p < 0.01), better dose conformity, lower doses to the heart, lungs and contralateral breast. Survival benefit was most predominant for patients with high-risk breast cancer (> 7% and > 4.5% gain for non-smokers and smokers). For smokers with intermediate-or low-risk breast cancer, RT induced mortality risk dominated for all techniques. When considering the risk of local recurrence, RT benefitted also smokers (> 5% and > 2% for intermediate-and low-risk cancer). Conclusions: PQM methodology was suggested for breast cancer radiotherapy evaluation. Further validation is needed. RT was beneficial for all patients with high risk of recurrence. A survival benefit for smokers with low or intermediate risk of recurrence could not be confirmed.

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Section: Discussionmentioning

confidence: 99%

Integration of biological factors in the treatment plan evaluation in breast cancer radiotherapy

Svensson

Lundstedt

Hällje

et al. 2019

Physics and Imaging in Radiation Oncology

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“…The authors showed an increase in clinical acceptance, and an improved quality and efficiency as compared to the current treatment planning process, allowing faster adoption of modern treatment for breast cancer patients. Promising results for treatment planning of the breast combined with the nodal regions are obtained using volumetric modulated arc therapy (VMAT) [ 52 ]. The authors obtained a good quality of the obtained dose distributions, comparable to manually prepared treatment plans, with substantially shorter total planning times: average 163 ± 97 and 33 ± 5 min for manual and automated plans, respectively, with approximately 130 and 5 min of user interaction.…”

Section: Ai In Breast Cancer Rt Planningmentioning

confidence: 99%

Winter is over: The use of Artificial Intelligence to individualise radiation therapy for breast cancer

et al. 2020

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Artificial intelligence demonstrated its value for automated contouring of organs at risk and target volumes as well as for auto-planning of radiation dose distributions in terms of saving time, increasing consistency, and improving dose-volumes parameters. Future developments include incorporating dose/outcome data to optimise dose distributions with optimal coverage of the high-risk areas, while at the same time limiting doses to low-risk areas. An infinite gradient of volumes and doses to deliver spatially-adjusted radiation can be generated, allowing to avoid unnecessary radiation to organs at risk. Therefore, data about patient-, tumour-, and treatment-related factors have to be combined with dose distributions and outcome-containing databases.

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“…Several approaches have been proposed to improve inhomogeneities in the junction region [7][8][9][10][11][12][13][14][15][16][17][18]. Intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) for breast cancer treatment have been proposed to provide better dosimetric results and to improve dose conformity to the target [9][10][11][12][13][14][15][16][17][18]. Most hybrid VMAT planning studies for breast treatment have used either IMRT or VMAT, which uses open tangential threedimensional conformal radiotherapy (3D-CRT) elds with main dose weighting as a base dose plan [9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Improved robustness in the junction region for postoperative breast cancer including supraclavicular nodes using hybrid VMAT

Miura¹,

Doi²,

Nakao³

et al. 2021

Preprint

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Purpose To improve the hybrid VMAT treatment plan robustness for postoperative breast cancer patients considering small patient motion shifts during treatment using a 3D-CRT with a dose gradient in the junction region. Methods Locoregional supraclavicular nodes of breast cancer patients were planned using 3D-CRT and VMAT. A 3D-CRT plan with a dose gradient on the cranial side was applied by shifting the jaw to reduce hot or cold spots. The VMAT plan was optimized based on the results of the 3D-CRT plan calculation. Hybrid plans were created by the sum of the 3D-CRT and VMAT plans. To simulate patient motion, the plans were recalculated with the VMAT plan simulating isocenter superiorly (separation) or inferiorly (overlap) shifted by 1, 2, and 3 mm. The shifted plans were compared with the non-shifted plans considering the clinical target volume (CTV) (D98% or D2%). Results The D2% value of the CTV with perfectly aligned fields for the hybrid VMAT plan with high- or low-dose gradients on the 3D-CRT plan increased from 102.8%/102.9–107.2%/105.7%, 114.9%/110.9%, and 122.2%/115.5% for each 1 mm, 2 mm, and 3 mm overlapped shift, respectively. The value of D98% to the CTV with perfectly aligned fields decreased from 95.7%/95.6–90.0%/93.1%, 81.2%/88.4%, and 72.8%/83.5% for each 1 mm, 2 mm, and 3 mm separated shift, respectively. Conclusions By employing a 3D-CRT plan with a low dose gradient on the cranial side, the dose differences can be decreased. A more robust treatment delivery option can be achieved for breast cancer treatment using our proposed hybrid VMAT.

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Personalized automated treatment planning for breast plus locoregional lymph nodes using Hybrid RapidArc

Cited by 33 publications

References 18 publications

Integration of biological factors in the treatment plan evaluation in breast cancer radiotherapy

Integration of biological factors in the treatment plan evaluation in breast cancer radiotherapy

Winter is over: The use of Artificial Intelligence to individualise radiation therapy for breast cancer

Improved robustness in the junction region for postoperative breast cancer including supraclavicular nodes using hybrid VMAT

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