Multicriteria optimization enables less experienced planners to efficiently produce high quality treatment plans in head and neck cancer radiotherapy

Radiation Oncology

Erik W Korevaar²  Roel JHM Steenbakkers²  Aart A van ‘t Veld²  Johannes A Langendijk²  Hendrik P Bijl²  Ruurd Visser¹  Roel GJ Kierkels² 

[1] Department of Medical Imaging and Radiation Therapy, Hanze University of Applied Sciences, Groningen, the Netherlands;Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen 9700 RB, the Netherlands

关键词: Treatment planning;    Head and neck cancer;    Intensity-modulated radiotherapy;    Multicriteria optimization;   

Others  :  1164477
DOI  :  10.1186/s13014-015-0385-9

 received in 2014-11-23, accepted in 2015-03-17,  发布年份 2015

【 摘 要 】

Objectives

To demonstrate that novice dosimetry planners efficiently create clinically acceptable IMRT plans for head and neck cancer (HNC) patients using a commercially available multicriteria optimization (MCO) system.

Methods

Twenty HNC patients were enrolled in this in-silico comparative planning study. Per patient, novice planners with less experience in dosimetry planning created an IMRT plan using an MCO system (RayStation). Furthermore, a conventionally planned clinical IMRT plan was available (Pinnacle³). All conventional IMRT and MCO-plans were blind-rated by two expert radiation-oncologists in HNC, using a 5-point scale (1–5 with 5 the highest score) assessment form comprising 10 questions. Additionally, plan quality was reported in terms of planning time, dosimetric and normal tissue complication probability (NTCP) comparisons. Inter-rater reliability was derived using the intra-class correlation coefficient (ICC).

Results

In total, the radiation-oncologists rated 800 items on plan quality. The overall plan score indicated no differences between both planning techniques (conventional IMRT: 3.8 ± 1.2 vs. MCO: 3.6 ± 1.1, p = 0.29). The inter-rater reliability of all ratings was 0.65 (95% CI: 0.57–0.71), indicating substantial agreement between the radiation-oncologists. In 93% of cases, the scoring difference of the conventional IMRT and MCO-plans was one point or less. Furthermore, MCO-plans led to slightly higher dose uniformity in the therapeutic planning target volume, to a lower integral body dose (13.9 ± 4.5 Gy vs. 12.9 ± 4.0 Gy, p < 0.001), and to reduced dose to the contra-lateral parotid gland (28.1 ± 11.8 Gy vs. 23.0 ± 11.2 Gy, p < 0.002). Consequently, NTCP estimates for xerostomia reduced by 8.4 ± 7.4% (p < 0.003). The hands-on time of the conventional IMRT planning was approximately 205 min. The time to create an MCO-plan was on average 43 ± 12 min.

Conclusions

MCO planning enables novice treatment planners to create high quality IMRT plans for HNC patients. Plans were created with vastly reduced planning times, requiring less resources and a short learning curve.

【 授权许可】

   
2015 Kierkels et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

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