Improvement in plan quality after Implementation of clinical goals in a large network of cancer centers

Hefei Liu; Praveen Nuksani; Malolan Rajagopalan; Mangesh Patil; Krishna Komanduri; Brent Murphy; Deepak Khuntia; Sushil Beriwal

doi:10.1016/j.meddos.2022.10.003

Improvement in plan quality after Implementation of clinical goals in a large network of cancer centers

Med Dosim. 2023;48(1):51-54. doi: 10.1016/j.meddos.2022.10.003. Epub 2022 Nov 18.

Authors

Hefei Liu¹, Praveen Nuksani², Malolan Rajagopalan³, Mangesh Patil⁴, Krishna Komanduri², Brent Murphy², Deepak Khuntia², Sushil Beriwal⁵

Affiliations

¹ Varian Medical systems Inc, Palo Alto, CA, USA; Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, WI, USA.
² Varian Medical systems Inc, Palo Alto, CA, USA.
³ Mount Carmel Health System, Columbus, OH, USA.
⁴ American Oncology Institute, Hyderabad, India.
⁵ Varian Medical systems Inc, Palo Alto, CA, USA; Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA. Electronic address: Sushilberiwal@gmail.com.

PMID: 36411200
DOI: 10.1016/j.meddos.2022.10.003

Abstract

Clinical Goals (CG) is a tool available in the Varian Eclipse planning system to objectively and visually evaluate the quality of treatment plans based upon user-defined dose-volume parameters. We defined a set of CG for Stereotactic Radiosurgery (SRS) and Intensity-Modulated Radiotherapy (IMRT) based on published data and guidelines and implemented this in a network of cancer centers in India (American Institute of Oncology). A dosimetric study was performed to compare brain SRS and breast IMRT plan quality before and after CG implementation.The CG defined for SRS plans were target V_100% ≥ 98%, dose gradient measure (GM) ≤ 0.5 cm, conformity index (CI) 1.0 to 1.2. For breast IMRT plans, CG defined target V_100% ≥ 97%, V_95% ≥ 95%, V_107% ≤ 2%, V_105% ≤ 10%, and D_max ≤ 2.4 Gy. Dose limits to organs-at-risk (OAR) were summarize in supplemental materials. Twenty brain SRS and 10 breast IMRT treatment plans that were previously delivered on patients were selected and re-planned using CG. The pre and postoptimized plan parameters were compared using student t-tests.For brain SRS plans, the V₁₀₀, GM, and CI for the pre- and post-Clinical-Goals plans were 93.22% ± 7.2% vs 97.96% ± 0.29% (p = 0.009), 0.63 ± 0.16 vs 0.42 ± 0.05 (p < 0.001) and 1.07 ± 0.18 vs 1.06 ± 0.06 (p = 0.79), respectively. There were no differences in max dose to OARs. In breast IMRT plans, the target V_107% for pre and postimplemented plans were 16.50% ± 10.98% vs 0.32% ± 0.32%, respectively (p = 0.001). The average target V_105% were 44.00% ± 15.72% and 8.69% ± 4.53%, respectively (p < 0.001). No differences were found in the average target V_100% (p = 0.128) and V_95% (p = 0.205). The average target D_max were 112.28% ± 1.59% and 109.14% ± 0.73%, respectively (p < 0.001). There were only minor differences in doses to OARs.The implementation of CG in Varian Eclipse significantly improved SRS and IMRT plan quality with enhanced coverage, dose GM, and CI without increased dose to OARs.

Keywords: Clinical goals; IMRT; SRS; Varian eclipse.

MeSH terms

Goals
Humans
Neoplasms*
Radiosurgery*
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Intensity-Modulated*