The challenge of planning vertebral body SBRT: Optimizing target volume coverage

Hardcastle, Nicholas; Bignell, Fiona; Nelms, Benjamin E.; Kneebone, Andrew; Lao, Louis; Cook, O.; Harris, Monica; Shakeshaft, John

doi:10.1016/j.meddos.2020.02.005

Cited by 11 publications

(12 citation statements)

References 14 publications

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“…Large efforts have been made by several authors to define a composite score or figure of merit for quantifying overall plan quality [25][26][27][28][29] and there is a commercial tool available [30,31]. These quality indices are practical as decision-support systems when comparing plans for the same patient [32] and have also been used for evaluating plan quality across different patients and platforms [24] and in treatment planning competitions [33][34][35]. However, which parameters to consider and their weights is not a straightforward decision and involves a certain degree of subjectivity.…”

Section: Dose Metricsmentioning

confidence: 99%

What is plan quality in radiotherapy? The importance of evaluating dose metrics, complexity, and robustness of treatment plans

Hernández

Hansen

Widesott³

et al. 2020

Radiotherapy and Oncology

134

114

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Plan evaluation is a key step in the radiotherapy treatment workflow. Central to this step is the assessment of treatment plan quality. Hence, it is important to agree on what we mean by plan quality and to be fully aware of which parameters it depends on. We understand plan quality in radiotherapy as the clinical suitability of the delivered dose distribution that can be realistically expected from a treatment plan. Plan quality is commonly assessed by evaluating the dose distribution calculated by the treatment planning system (TPS). Evaluating the 3D dose distribution is not easy, however; it is hard to fully evaluate its spatial characteristics and we still lack the knowledge for personalising the prediction of the clinical outcome based on individual patient characteristics. This advocates for standardisation and systematic collection of clinical data and outcomes after radiotherapy. Additionally, the calculated dose distribution is not exactly the dose delivered to the patient due to uncertainties in the dose calculation and the treatment delivery, including variations in the patient set-up and anatomy. Consequently, plan quality also depends on the robustness and complexity of the treatment plan. We believe that future work and consensus on the best metrics for quality indices are required. Better tools are needed in TPSs for the evaluation of dose distributions, for the robust evaluation and optimisation of treatment plans, and for controlling and reporting plan complexity. Implementation of such tools and a better understanding of these concepts will facilitate the handling of these characteristics in clinical practice and be helpful to increase the overall quality of treatment plans in radiotherapy.

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Section: Dose Metricsmentioning

confidence: 99%

What is plan quality in radiotherapy? The importance of evaluating dose metrics, complexity, and robustness of treatment plans

Hernández

Hansen

Widesott³

et al. 2020

Radiotherapy and Oncology

134

114

View full text Add to dashboard Cite

show abstract

“…In cases wherein the tumor is adjacent to the spinal cord [minimum distance between the GTV and planning organ-at-risk volume (PRV) of the cord < 3 mm [ 40 ]], we may have to increase the number of the fraction size of SBRT. A dose constraint of the spinal cord for the radiation-naive region is 12.4 Gy in a single fraction [ 41 ], resulting in a delivery of 27.78 Gy [biological equivalent dose with α/β = 10 (BED10)] to the epidural tumor in contact with the spinal cord. In a regimen involving five fractions, as the spinal cord dose constraint would be 25.3 Gy [ 41 ], 38.10 Gy (BED10) can be administered to the epidural tumors.…”

Section: Optimal Methodologymentioning

confidence: 99%

Stereotactic body radiotherapy for spinal oligometastases: a review on patient selection and the optimal methodology

2022

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Stereotactic body radiotherapy (SBRT) has excellent local control and low toxicity for spinal metastases and is widely performed for spinal oligometastases. However, its additional survival benefit to standard of care, including systemic therapy, is unknown because the results of large-scale randomized controlled trials regarding SBRT for oligometastases have not been reported. Consequently, the optimal patient population among those with spinal oligometastases and the optimal methodology for spine SBRT remain unclear. The present review article discusses two topics: evidence-based optimal patient selection and methodology. The following have been reported to be good prognostic factors: young age, good performance status, slow-growing disease with a long disease-free interval, minimal disease burden, and mild fluorodeoxyglucose accumulation in positron emission tomography. In addition, we proposed four measures as the optimal SBRT method for achieving excellent local control: (i) required target delineation; (ii) recommended dose fraction schedule (20 or 24 Gy in a single fraction for spinal oligometastases and 35 Gy in five fractions for lesions located near the spinal cord); (iii) optimizing dose distribution for the target; (iv) dose constraint options for the spinal cord.

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“…Moghanaki et al have recently adopted a crowdsourcing approach to analyze the quality and variability of a large number of stereotactic body radiotherapy plans for a single case of lung cancer using a web-based platform [15]. Hardcastle et al investigated the challenges of spinal radiosurgery by crowdsourcing 149 plans of spinal radiosurgery from an international plan challenge study that was organized by the Trans-Tasmania Radiation Oncology Group (TROG) [16]. The same group also crowdsourced 160 plans for a case of SRS to five brain metastases from the other international planning study [17].…”

Section: Introductionmentioning

confidence: 99%

Multi-center planning study of radiosurgery for intracranial metastases through Automation (MC-PRIMA) by crowdsourcing prior web-based plan challenge study

Chan

Gevaert

Dörr³

et al. 2022

Physica Medica

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Background: Planning radiosurgery to multiple intracranial metastases is complex and shows large variability in dosimetric quality among planners and treatment planning systems (TPS). This project aimed to determine whether autoplanning using the Muliple Brain Mets (AutoMBM) software can improve plan quality and reduce inter-planner variability by crowdsourcing results from prior international planning study. Methods: Twenty-four institutions autoplanned with AutoMBM on a five metastases case from a prior international planning competition from which population statistics (means and variances) of 23 dosimetric metrics and resulting composite plan score (maximum score = 150) of other TPS (Eclipse, Monaco, RayStation, iPlan, GammaPlan, MultiPlan) were crowdsourced. Plan results of AutoMBM and each of the other TPS were compared using two sample t-tests for means and Levene's tests for variances. Plan quality of AutoMBM was correlated with the planner' experience and compared between academic and non-academic centers. Results: AutoMBM produced plans with comparable composite plan score to GammaPlan, MultiPlan, Eclipse and iPlan (127.6 vs. 131.7 vs. 127.3 vs. 127.3 and 126.7; all p > 0.05) and superior to Monaco and RayStation (118.3 and 108.6; both p < 0.05). Inter-planner variability of overall plan quality was lowest for AutoMBM among all TPS (all p < 0.05). AutoMBM's plan quality did not differ between academic and non-academic centers and uncorrelated with planning experience (all p > 0.05).

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The challenge of planning vertebral body SBRT: Optimizing target volume coverage

Cited by 11 publications

References 14 publications

What is plan quality in radiotherapy? The importance of evaluating dose metrics, complexity, and robustness of treatment plans

What is plan quality in radiotherapy? The importance of evaluating dose metrics, complexity, and robustness of treatment plans

Stereotactic body radiotherapy for spinal oligometastases: a review on patient selection and the optimal methodology

Multi-center planning study of radiosurgery for intracranial metastases through Automation (MC-PRIMA) by crowdsourcing prior web-based plan challenge study

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