Knowledge-Based Planning for Identifying High-Risk Stereotactic Ablative Radiation Therapy Treatment Plans for Lung Tumors Larger Than 5 cm
| Autor: | Saar van ’t Hof, Max Dahele, Jos W. R. Twisk, Alexander R. Delaney, Ben J. Slotman, H. Tekatli, Wilko F.A.R. Verbakel, Suresh Senan |
|---|---|
| Přispěvatelé: | Radiation Oncology, CCA - Cancer Treatment and quality of life, APH - Methodology, APH - Health Behaviors & Chronic Diseases, Epidemiology and Data Science, CCA - Clinical Therapy Development, ACS - Atherosclerosis & ischemic syndromes |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Organs at Risk
Cancer Research medicine.medical_specialty Lung Neoplasms Knowledge Bases medicine.medical_treatment Atelectasis Radiosurgery SABR volatility model 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine medicine Humans Dosimetry Radiology Nuclear Medicine and imaging Radiation treatment planning Radiation business.industry Radiotherapy Planning Computer-Assisted Radiotherapy Dosage medicine.disease Radiation therapy Stenosis Oncology 030220 oncology & carcinogenesis Toxicity Radiology Airway business |
| Zdroj: | International journal of radiation oncology, biology, physics, 103(1), 259-267. Elsevier Inc. Hof, S V T, Delaney, A R, Tekatli, H, Twisk, J, Slotman, B J, Senan, S, Dahele, M & Verbakel, W F 2019, ' Knowledge-Based Planning for Identifying High-Risk Stereotactic Ablative Radiation Therapy Treatment Plans for Lung Tumors Larger Than 5 cm ', International journal of radiation oncology, biology, physics, vol. 103, no. 1, pp. 259-267 . https://doi.org/10.1016/j.ijrobp.2018.08.013 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2018.08.013 |
| Popis: | Purpose Stereotactic ablative body radiation therapy (SABR) for lung tumors ≥5 cm can be associated with more toxicity than that for smaller tumors. We investigated the relationship between dosimetry and toxicity and used a knowledge-based planning solution to retrospectively perform individualized treatment plan quality assurance (QA) with the aim of identifying where planning could have been improved. Methods and Materials Previous retrospective analysis of 53 patients with primary or recurrent non-small cell lung cancer ≥5 cm, treated with 5- or 8-fraction volumetric modulated arc therapy SABR between 2008 and 2014, showed 30% with grade ≥3 toxicity. During this period, several improvements were made to departmental planning protocols. RapidPlan was used to compare dosimetry of patients with or without grade ≥3 toxicity. A model comprising plans from patients without toxicity and compliant with the current planning protocol was used to provide QA for the plans from patients who had toxicity. Results Sixteen of 53 patients had grade ≥3 toxicity, including 10 with radiation pneumonitis (RP), 3 with lung hemorrhage (1 of these also had RP), and 1 with airway stenosis/atelectasis. RP was again shown to be significantly correlated with contralateral and total-lung V5 and mean lung dose. The 4 highest contralateral-lung doses belonged to patients with RP. Five of 10 clinical plans in patients with RP had a contralateral-lung mean dose up to 2.5 times higher than that of the knowledge-based plan. For 2 of 3 patients with lung hemorrhage and 1 with airway stenosis/atelectasis, the clinical plans had the highest proximal bronchial tree doses, which was also higher than in plans from the model. In 8 patients with grade ≥3 toxicity, clinical plans had dosimetry similar to that in the predictions from the model. Conclusions A “no-toxicity” RapidPlan model identified the potential for dosimetric improvement in nearly 50% of historical treatment plans from patients with grade ≥3 toxicity after SABR for lung tumors ≥5 cm. Model-based QA may be useful for benchmarking treatment planning protocols in routine practice and in clinical studies. |
| Databáze: | OpenAIRE |
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