Hansen Christian Rønn, Nielsen Morten, Bertelsen Anders Smedegaard, Hazell Irene, Holtved Eva, Zukauskaite Ruta, Bjerregaard Jon Kroll, Brink Carsten, Bernchou Uffe
a Laboratory of Radiation Physics , Odense University Hospital , Odense , Denmark.
b Institute of Clinical Research , University of Southern Denmark , Odense , Denmark.
Acta Oncol. 2017 Nov;56(11):1495-1500. doi: 10.1080/0284186X.2017.1349928. Epub 2017 Aug 25.
The quality of radiotherapy planning has improved substantially in the last decade with the introduction of intensity modulated radiotherapy. The purpose of this study was to analyze the plan quality and efficacy of automatically (AU) generated VMAT plans for inoperable esophageal cancer patients.
Thirty-two consecutive inoperable patients with esophageal cancer originally treated with manually (MA) generated volumetric modulated arc therapy (VMAT) plans were retrospectively replanned using an auto-planning engine. All plans were optimized with one full 6MV VMAT arc giving 60 Gy to the primary target and 50 Gy to the elective target. The planning techniques were blinded before clinical evaluation by three specialized oncologists. To supplement the clinical evaluation, the optimization time for the AU plan was recorded along with DVH parameters for all plans.
Upon clinical evaluation, the AU plan was preferred for 31/32 patients, and for one patient, there was no difference in the plans. In terms of DVH parameters, similar target coverage was obtained between the two planning methods. The mean dose for the spinal cord increased by 1.8 Gy using AU (p = .002), whereas the mean lung dose decreased by 1.9 Gy (p < .001). The AU plans were more modulated as seen by the increase of 12% in mean MUs (p = .001). The median optimization time for AU plans was 117 min.
The AU plans were in general preferred and showed a lower mean dose to the lungs. The automation of the planning process generated esophageal cancer treatment plans quickly and with high quality.
在过去十年中，随着调强放疗的引入，放射治疗计划的质量有了显著提高。本研究的目的是分析自动（AU）生成的容积调强弧形放疗（VMAT）计划用于不可切除食管癌患者的计划质量和疗效。
对32例最初接受手动（MA）生成的VMAT计划治疗的不可切除食管癌患者进行回顾性重新计划，使用自动计划引擎。所有计划均采用一个完整的6MV VMAT弧进行优化，给予原发靶区60 Gy，选择性靶区50 Gy。在由三名专业肿瘤学家进行临床评估之前，规划技术是保密的。为补充临床评估，记录了AU计划的优化时间以及所有计划的剂量体积直方图（DVH）参数。
经临床评估，31/32例患者更倾向于AU计划，1例患者的两种计划无差异。在DVH参数方面，两种规划方法获得了相似的靶区覆盖。使用AU时，脊髓的平均剂量增加了1.8 Gy（p = 0.002），而肺的平均剂量降低了1.9 Gy（p < 0.001）。从平均跳数增加12%可以看出，AU计划的调制更多（p = 0.001）。AU计划的中位优化时间为117分钟。
总体而言，AU计划更受青睐，且对肺的平均剂量较低。计划过程的自动化快速且高质量地生成了食管癌治疗计划。
