Abstract
BackgroundFor several tumor entities, automated treatment planning has improved plan quality and planning efficiency, and may enable adaptive treatment approaches. Whole-pelvic prostate radiotherapy (WPRT) involves large concave target volumes, which present a challenge for volumetric arc therapy (VMAT) optimization. This study evaluates automated VMAT planning for WPRT-VMAT and compares the results with manual expert planning.MethodsA system for fully automated multi-criterial plan generation was configured for each step of sequential-boost WPRT-VMAT, with final “autoVMAT” plans being automatically calculated by the Monaco treatment planning system (TPS; Elekta AB, Stockholm, Sweden). Configuration was based on manually generated VMAT plans (manualVMAT) of 5 test patients, the planning protocol, and discussions with the treating physician on wishes for plan improvements. AutoVMAT plans were then generated for another 30 evaluation patients and compared to manualVMAT plans. For all 35 patients, manualVMAT plans were optimized by expert planners using the Monaco TPS.ResultsAutoVMAT plans exhibited strongly improved organ sparing and higher conformity compared to manualVMAT. On average, mean doses (Dmean) of bladder and rectum were reduced by 10.7 and 4.5 Gy, respectively, by autoVMAT. Prostate target coverage (V95%) was slightly higher (+0.6%) with manualVMAT. In a blinded scoring session, the radiation oncologist preferred autoVMAT plans to manualVMAT plans for 27/30 patients. All treatment plans were considered clinically acceptable. The workload per patient was reduced by > 70 min.ConclusionAutomated VMAT planning for complex WPRT dose distributions is feasible and creates treatment plans that are generally dosimetrically superior to manually optimized plans.
Highlights
For several tumor entities, automated treatment planning has improved plan quality and planning efficiency, and may enable adaptive treatment approaches
This study investigates the feasibility of automated generation of volumetric arc therapy (VMAT) plans for Whole-pelvic prostate radiotherapy (WPRT) with Erasmus-iCycle/ Monaco and compares the resulting dose distributions with manually optimized VMAT plans that were generated by expert planners in a different center, using Monaco
All generated autoVMAT and manualVMAT dose distributions fulfilled the criteria for clinical acceptability in terms of organs at risk (OAR) sparing and target coverage
Summary
For several tumor entities, automated treatment planning has improved plan quality and planning efficiency, and may enable adaptive treatment approaches. This study evaluates automated VMAT planning for WPRT-VMAT and compares the results with manual expert planning. Methods A system for fully automated multi-criterial plan generation was configured for each step of sequential-boost WPRT-VMAT, with final “autoVMAT” plans being automatically calculated by the Monaco treatment planning system (TPS; Elekta AB, Stockholm, Sweden). Configuration was based on manually generated VMAT plans (manualVMAT) of 5 test patients, the planning protocol, and discussions with the treating physician on wishes for plan improvements. AutoVMAT plans were generated for another 30 evaluation patients and compared to manualVMAT plans. For all 35 patients, manualVMAT plans were optimized by expert planners using the Monaco TPS. Results AutoVMAT plans exhibited strongly improved organ sparing and higher conformity compared to manualVMAT. In a blinded scoring session, the radiation oncologist preferred autoVMAT plans to manualVMAT plans for 27/30 patients. The workload per patient was reduced by > 70 min
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