Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
Phys Med. 2021 Feb;82:7-16. doi: 10.1016/j.ejmp.2020.12.015. Epub 2021 Jan 25.
To perform a comprehensive dosimetric and clinical evaluation of the new Pinnacle Personalized automated planning system for complex head-and-neck treatments.
Fifteen consecutive head-neck patients were enrolled. Radiotherapy was prescribed using VMAT with simultaneous integrated boost strategy. Personalized planning integrates the Feasibility engine able to supply an "a priori" DVH prediction of the achievability of planning goals. Comparison between clinically accepted manually-generated (MP) and automated (AP) plans was performed using dose-volume histograms and a blinded clinical evaluation by two radiation oncologists. Planning time between MP and AP was compared. Dose accuracy was validated using the PTW Octavius-4D phantom together with the 1500 2D-array.
For similar targets coverage, AP plans reported less irradiation of healthy tissue, with significant dose reduction for spinal cord, brainstem and parotids. On average, the mean dose to parotids and maximal doses to spinal cord and brainstem were reduced by 13-15% (p < 0.001), 9% (p < 0.001) and 16% (p < 0.001), respectively. The integral dose was reduced by 16% (p < 0.001). The dose conformity for the three PTVs was significantly higher with AP plans (p < 0.001). The two oncologists chose AP plans in more than 80% of cases. Overall planning times were reduced to <30 min for automated optimization. All AP plans passed the 3%/2 mm γ-analysis by more than 95%.
Complex head-neck plans created using Personalized automated engine provided an overall increase of plan quality, in terms of dose conformity and sparing of normal tissues. The Feasibility module allowed OARs dose sparing well beyond the clinical objectives.
对新的 Pinnacle Personalized 自动化计划系统进行全面的剂量学和临床评估，以治疗复杂的头颈部肿瘤。
共纳入 15 例头颈部肿瘤患者。采用 VMAT 同步整合boost 策略进行放射治疗。个性化计划整合了可行性引擎，能够提供计划目标可实现性的“先验”DVH 预测。通过剂量-体积直方图和两位放射肿瘤学家的盲法临床评估，对临床可接受的手动生成（MP）和自动化（AP）计划进行比较。比较了 MP 和 AP 之间的计划时间。使用 PTW Octavius-4D 体模和 1500 个 2D 阵列验证剂量准确性。
对于相似的靶区覆盖，AP 计划报告的健康组织照射量较少，脊髓、脑干和腮腺的剂量明显降低。平均而言，腮腺的平均剂量和脊髓、脑干的最大剂量分别降低了 13-15%（p<0.001）、9%（p<0.001）和 16%（p<0.001）。整体剂量降低了 16%（p<0.001）。AP 计划的三个 PTV 的剂量适形度显著提高（p<0.001）。两位肿瘤学家在超过 80%的情况下选择了 AP 计划。自动优化的整体计划时间减少到<30 分钟。所有 AP 计划均通过了 3%/2mmγ 分析，通过率超过 95%。
使用个性化自动化引擎创建的复杂头颈部计划在剂量适形度和正常组织保护方面提高了整体计划质量。可行性模块允许 OAR 剂量的节省远远超过临床目标。
