Abstract
PurposeTo develop and evaluate a fast, automated multi-criterial treatment planning approach for adaptive high-dose-rate (HDR) intracavitary + interstitial brachytherapy (BT) for locally advanced cervical cancer. Methods and materialsTwenty-two previously delivered single fraction MRI-based HDR treatment plans (SFclin) were used to guide training of our in-house system for multi-criterial autoplanning, aiming for an autoplan quality superior to the training plans, while respecting the clinically desired “pear-shaped” dose distribution. Next, the configured algorithm was used to automatically generate treatment plans for 63 other fractions (SFauto). The SFauto plans were compared to the corresponding SFclin plans in blind pairwise comparisons by an expert clinician. Then, the effect of adaptive autoplanning on total treatment (TT) plans (external beam + 3 BT fractions) was evaluated for 16 patients by simulating the clinically applied adaptive strategy to generate TTauto plans and compare them with the corresponding clinical treatments (TTclin). ResultsIn the blind comparisons, all SFauto plans were considered clinically acceptable. In 62/63 comparisons, SFauto plans were considered at least as good as, or better than the corresponding SFclin. The average optimization time for autoplanning was 20.5 ± 19.2 s (range 4.4–106.4 s) per plan. In 14 of 16 TTauto plans, the desired total dose of 90 Gy (EQD2) was obtained, compared to only 9 in the corresponding TTclin, while autoplanning also decreased bladder and rectum doses. ConclusionsFast, fully-automated multi-criterial treatment planning for adaptive HDR-BT for locally advanced cervical cancer is feasible. Autoplans were superior to corresponding clinical plans.
Highlights
In 60/63 cases single fraction autoplans (SFauto) was preferred over SFclin, in 2/63 cases the quality of the plans was considered equal and for 1/63 cases SFclin was preferred over SFauto because of a more favorable small bowel dose
To the best of our knowledge, we have presented the first automated multi-criterial treatment planning solution considering each of the complexities, and capable of generating clinically favorable dose distributions
All 63 single fraction autoplans were considered clinically acceptable by the expert clinician, and 62 of the 63 autoplans were scored similar or better than the clinically delivered plans
Summary
Objectives per fractionPriority p1 2 3 4 5 6 6 6 6, weight 4* 7CTVHR (T) Pear Pear Inside Needles CTVHR Bladder Rectum Sigmoid Small Bowel CTVHR.
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