Validation of Fully Automated Robust Multicriterial Treatment Planning for Head and Neck Cancer IMPT

Merle Huiskes; Wens Kong; Michelle Oud; Koen Crama; Coen Rasch; Sebastiaan Breedveld; Ben Heijmen; Eleftheria Astreinidou

doi:10.1016/j.ijrobp.2023.12.034

Validation of Fully Automated Robust Multicriterial Treatment Planning for Head and Neck Cancer IMPT

Int J Radiat Oncol Biol Phys. 2024 Jul 1;119(3):968-977. doi: 10.1016/j.ijrobp.2023.12.034. Epub 2024 Jan 27.

Authors

Merle Huiskes¹, Wens Kong², Michelle Oud², Koen Crama³, Coen Rasch³, Sebastiaan Breedveld², Ben Heijmen², Eleftheria Astreinidou⁴

Affiliations

¹ Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: m.huiskes@lumc.nl.
² Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
³ Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; HollandPTC, Delft, The Netherlands.
⁴ Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.

PMID: 38284961
DOI: 10.1016/j.ijrobp.2023.12.034

Abstract

Purpose: Our purpose was to compare robust intensity modulated proton therapy (IMPT) plans, automatically generated with wish-list-based multicriterial optimization as implemented in Erasmus-iCycle, with manually created robust clinical IMPT plans for patients with head and neck cancer.

Methods and materials: Thirty-three patients with head and neck cancer were retrospectively included. All patients were previously treated with a manually created IMPT plan with 7000 cGy dose prescription to the primary tumor (clinical target volume [CTV]7000) and 5425 cGy dose prescription to the bilateral elective volumes (CTV5425). Plans had a 4-beam field configuration and were generated with scenario-based robust optimization (21 scenarios, 3-mm setup error, and ±3% density uncertainty for the CTVs). Three clinical plans were used to configure the Erasmus-iCycle wish-list for automated generation of robust IMPT plans for the other 30 included patients, in line with clinical planning requirements. Automatically and manually generated IMPT plans were compared for (robust) target coverage, organ-at-risk (OAR) doses, and normal tissue complication probabilities (NTCP). No manual fine-tuning of automatically generated plans was performed.

Results: For all automatically generated plans, voxel-wise minimum D_98% values for the CTVs were within clinical constraints and similar to manual plans. All investigated OAR parameters were favorable in the automatically generated plans (all P < .001). Median reductions in mean dose to OARs went up to 667 cGy for the inferior pharyngeal constrictor muscle, and median reductions in D_0.03cm³ in serial OARs ranged up to 1795 cGy for the spinal cord surface. The observed lower mean dose in parallel OARs resulted in statistically significant lower NTCP for xerostomia (grade ≥2: 34.4% vs 38.0%; grade ≥3: 9.0% vs 10.2%) and dysphagia (grade ≥2: 11.8% vs 15.0%; grade ≥3: 1.8% vs 2.8%).

Conclusions: Erasmus-iCycle was able to produce IMPT dose distributions fully automatically with similar (robust) target coverage and improved OAR doses and NTCPs compared with clinical manual planning, with negligible hands-on planning workload.

Publication types

Validation Study

MeSH terms

Automation
Head and Neck Neoplasms* / diagnostic imaging
Head and Neck Neoplasms* / radiotherapy
Humans
Male
Organs at Risk* / diagnostic imaging
Organs at Risk* / radiation effects
Proton Therapy* / methods
Radiotherapy Dosage*
Radiotherapy Planning, Computer-Assisted* / methods
Radiotherapy Setup Errors / prevention & control
Radiotherapy, Intensity-Modulated* / methods
Retrospective Studies