Wood Maree, Fonseca Amara, Sampson David, Kovendy Andrew, Westhuyzen Justin, Shakespeare Thomas, Turnbull Kirsty
Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales 2450, Australia.
Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales 2480, Australia.
Rep Pract Oncol Radiother. 2016 Nov-Dec;21(6):567-570. doi: 10.1016/j.rpor.2016.09.005. Epub 2016 Sep 30.
The aim of the retrospective study was to develop a planning class solution for prostate intensity-modulated radiotherapy (IMRT) that achieved target and organs-at-risk (OAR) doses within acceptable departmental protocol criteria using the Monaco treatment planning system (Elekta-CMS Software, MO, USA).
Advances in radiation therapy technology have led to a re-evaluation of work practices. Class solutions have the potential to produce highly conformal plans in a time-efficient manner.
Using data from intermediate and high risk prostate cancer patients, a stepwise quality improvement model was employed. Stage 1 involved the development of a broadly based treatment template developed across 10 patients. Stage 2 involved template refinement and clinical audit ( = 20); Stage 3, template review ( = 50) and Stage 4 an assessment of a revised template against the actual treatment plan involving 72 patients.
The computer algorithm that comprised the Stage 4 template met clinical treatment criteria for 82% of patients. Minor template changes were required for a further 13% of patients. Major changes were required in 4%; one patient could not be assessed. The average calculation time was 13 min and involved seven mouse clicks by the planner. Thus, the new template met treatment criteria or required only minor changes in 95% of prostate patients; this is an encouraging result suggesting improvements in planning efficiency and consistency.
It is feasible to develop a class solution for prostate IMRT using a stepwise quality improvement model which delivers clinically acceptable plans in the great majority of prostate cases.
这项回顾性研究的目的是利用Monaco治疗计划系统（美国密苏里州伊莱克塔 - 计算机医疗系统软件公司）开发一种前列腺调强放射治疗（IMRT）的计划类解决方案，该方案能在可接受的科室方案标准内实现靶区和危及器官（OAR）的剂量。
放射治疗技术的进步促使人们重新评估工作实践。计划类解决方案有潜力以高效的方式生成高度适形的计划。
使用中高危前列腺癌患者的数据，采用逐步质量改进模型。第1阶段涉及为10名患者开发一个基础广泛的治疗模板。第2阶段涉及模板细化和临床审核（n = 20）；第3阶段，模板审查（n = 50），第4阶段是根据涉及72名患者的实际治疗计划对修订后的模板进行评估。
构成第4阶段模板的计算机算法符合82%患者的临床治疗标准。另有13%的患者需要对模板进行 minor 更改。4%的患者需要进行 major 更改；1名患者无法评估。平均计算时间为13分钟，计划者只需点击鼠标7次。因此，新模板在95%的前列腺患者中符合治疗标准或只需进行 minor 更改；这是一个令人鼓舞的结果，表明计划效率和一致性有所提高。
使用逐步质量改进模型为前列腺IMRT开发一种计划类解决方案是可行的，该模型能在绝大多数前列腺病例中提供临床可接受的计划。
