a Department of Radiation Oncology , Erasmus MC Cancer Institute , Rotterdam , The Netherlands.
Acta Oncol. 2018 Nov;57(11):1490-1498. doi: 10.1080/0284186X.2018.1479068. Epub 2018 Jul 2.
For conventional radiotherapy treatment units, automated planning can significantly improve plan quality. For robotic radiosurgery, systems for automatic generation of clinically deliverable plans do not yet exist. For prostate stereotactic body radiation therapy (SBRT), few studies have systematically compared VMAT with robotic treatment.
The multi-criteria autoplanning optimizer, developed at our institute, was coupled to the commercial treatment planning system of our robotic treatment unit, for fully automated generation of clinically deliverable plans (autoROBOT). The system was then validated by comparing autoROBOT plans with manually generated plans. Next, the autoROBOT system was used for systematic comparisons between autoROBOT plans and VMAT plans, that were also automatically generated (autoVMAT). CTV-PTV margins of 3 mm were used for autoROBOT (clinical routine) and autoVMAT plan generation. For autoVMAT, an extra plan was generated with 5 mm margin (often applied for VMAT). Plans were generated for a 4 × 9.5 Gy fractionation scheme.
Compared to manual planning, autoROBOT improved rectum D[Formula: see text] (16%), V[Formula: see text] (75%) and D[Formula: see text] (41%), and bladder D[Formula: see text] (37%) (all p [Formula: see text] .002), with equal PTV coverage. In the autoROBOT and autoVMAT comparison, both with 3 mm margin, rectum doses were lower for autoROBOT by 5% for rectum D[Formula: see text] (p=.002), 33% for V[Formula: see text] (p=.001) and 4% for D[Formula: see text] (p=.05), with comparable PTV coverage and other OAR sparing. With 5 mm margin for VMAT, 18/20 plans had a PTV coverage lower than requested (<95%) and all plans had higher rectum doses than autoROBOT (mean percentage differences of 13% for D[Formula: see text], 69% for V[Formula: see text] and 32% for D[Formula: see text] (all p<.001)).
The first system for fully automated generation of clinically deliverable robotic plans was built. Autoplanning did largely enhance robotic plan quality, compared to manual planning. Using autoplanning for both the robotic system and VMAT, superiority of non-coplanar robotic treatment compared to coplanar VMAT for prostate SBRT was demonstrated.
对于传统的放射治疗设备，自动化规划可以显著提高计划质量。对于机器人放射外科手术，还没有用于自动生成临床可交付计划的系统。对于前列腺立体定向体放射治疗（SBRT），很少有研究系统地比较了容积旋转调强放疗（VMAT）与机器人治疗。
在我们的研究所开发的多标准自动规划优化器与我们的机器人治疗单元的商业治疗计划系统耦合，用于全自动生成临床可交付的计划（autoROBOT）。然后，通过比较自动生成的计划与手动生成的计划来验证系统。接下来，使用 autoROBOT 系统对自动生成的机器人计划（autoROBOT）与自动生成的 VMAT 计划（autoVMAT）进行系统比较。对于 autoROBOT 和 autoVMAT 计划生成，使用 3mm 的 CTV-PTV 边缘。对于 autoVMAT，生成了另一个 5mm 边缘的计划（常用于 VMAT）。计划是为 4×9.5Gy 分割方案生成的。
与手动规划相比，autoROBOT 改善了直肠 D[Formula: see text]（16%）、V[Formula: see text]（75%）和 D[Formula: see text]（41%），以及膀胱 D[Formula: see text]（37%）（均 p[Formula: see text]0.002），同时保持相同的 PTV 覆盖率。在 autoROBOT 和 autoVMAT 的比较中，对于直肠 D[Formula: see text]（p=0.002）、V[Formula: see text]（p=0.001）和 D[Formula: see text]（p=0.05），直肠剂量分别降低了 5%、33%和 4%，同时保持相似的 PTV 覆盖率和其他 OAR 保护。对于 VMAT 的 5mm 边缘，20 个计划中有 18 个的 PTV 覆盖率低于要求（[Formula: see text]95%），并且所有计划的直肠剂量都高于 autoROBOT（直肠 D[Formula: see text]、V[Formula: see text]和 D[Formula: see text]的平均百分比差异分别为 13%、69%和 32%，均 p[Formula: see text]0.001）。
构建了第一个全自动生成临床可交付机器人计划的系统。与手动规划相比，自动规划大大提高了机器人计划的质量。使用自动规划进行机器人系统和 VMAT 的治疗，证明了非共面机器人治疗与共面 VMAT 相比在前列腺 SBRT 中的优越性。
