Analysis of EORTC-1219-DAHANCA-29 trial plans demonstrates the potential of knowledge-based planning to provide patient-specific treatment plan quality assurance

Jim P Tol; Max Dahele; Vincent Gregoire; Jens Overgaard; Ben J Slotman; Wilko F A R Verbakel

doi:10.1016/j.radonc.2018.10.005

Analysis of EORTC-1219-DAHANCA-29 trial plans demonstrates the potential of knowledge-based planning to provide patient-specific treatment plan quality assurance

Radiother Oncol. 2019 Jan:130:75-81. doi: 10.1016/j.radonc.2018.10.005. Epub 2018 Oct 19.

Authors

Jim P Tol¹, Max Dahele², Vincent Gregoire³, Jens Overgaard⁴, Ben J Slotman², Wilko F A R Verbakel⁵

Affiliations

¹ VU University Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands. Electronic address: j.tol.vumc@gmail.com.
² VU University Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands.
³ Université catholique de Louvain, St-Luc University Hospital, Experimental and Clinical Research Institute, Center for Molecular Imaging, Oncology and Radiotherapy, Brussels, Belgium.
⁴ Aarhus University Hospital, Department of Experimental Clinical Oncology, Aarhus, Denmark.
⁵ VU University Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands. Electronic address: w.verbakel@vumc.nl.

PMID: 30348462
DOI: 10.1016/j.radonc.2018.10.005

Abstract

Introduction: Radiotherapy treatment plan quality can influence clinical trial outcomes and general QA may not identify suboptimal organ-at-risk (OAR) sparing. We retrospectively performed patient-specific quality assurance (QA) of 100 head-and-neck cancer (HNC) plans from the EORTC-1219-DAHANCA-29 study.

Materials and methods: A 177-patient RapidPlan (Varian Medical Systems) model comprising institutional HNC plans was used to QA trial plans (P_trial). RapidPlan plans (P_rapidplan) were created using RapidPlan and Eclipse scripting to achieve a high degree of automation. Comparison between P_rapidplan mean predicted/achieved OAR doses, and P_trial mean OAR doses was made for parotid/submandibular glands (PGs/SMGs) and swallowing muscles (SM).

Results: OAR predictions were made within 2 min per patient. Averaged PG/SMG/SM mean doses were 2.0/9.0/3.8 Gy lower in P_rapidplan. Using predicted P_rapidplan combined mean OAR dose as the benchmark, a total of 60/27/4 trial plans could be improved by 3/6/9 Gy respectively.

Discussion: Individualized QA indicated that OAR sparing could frequently be improved in EORTC-1219 study plans, even though they met the trial's generic plan criteria. Automated, patient-specific QA can be performed within a few minutes and should be considered to reduce the influence of planning variation on trial outcomes.

Keywords: Clinical trials; Head and neck cancer; Quality assurance; Treatment planning.

MeSH terms

Clinical Trials as Topic
Head and Neck Neoplasms / radiotherapy*
Humans
Organs at Risk
Parotid Gland / radiation effects
Quality Assurance, Health Care*
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted / standards*
Retrospective Studies