Fjellanger Kristine, Hysing Liv Bolstad, Heijmen Ben J M, Pettersen Helge Egil Seime, Sandvik Inger Marie, Sulen Turid Husevåg, Breedveld Sebastiaan, Rossi Linda
Department of Oncology and Medical Physics, Haukeland University Hospital, 5021 Bergen, Norway.
Institute of Physics and Technology, University of Bergen, 5007 Bergen, Norway.
Cancers (Basel). 2021 Nov 13;13(22):5683. doi: 10.3390/cancers13225683.
In this study, the novel iCE radiotherapy treatment planning system (TPS) for automated multi-criterial planning with integrated beam angle optimization (BAO) was developed, and applied to optimize organ at risk (OAR) sparing and systematically investigate the impact of beam angles on radiotherapy dose in locally advanced non-small cell lung cancer (LA-NSCLC). iCE consists of an in-house, sophisticated multi-criterial optimizer with integrated BAO, coupled to a broadly used commercial TPS. The in-house optimizer performs fluence map optimization to automatically generate an intensity-modulated radiotherapy (IMRT) plan with optimal beam angles for each patient. The obtained angles and dose-volume histograms are then used to automatically generate the final deliverable plan with the commercial TPS. For the majority of 26 LA-NSCLC patients, iCE achieved improved heart and esophagus sparing compared to the manually created clinical plans, with significant reductions in the median heart D (8.1 vs. 9.0 Gy, = 0.02) and esophagus D (18.5 vs. 20.3 Gy, = 0.02), and reductions of up to 6.7 Gy and 5.8 Gy for individual patients. iCE was superior to automated planning using manually selected beam angles. Differences in the OAR doses of iCE plans with 6 beams compared to 4 and 8 beams were statistically significant overall, but highly patient-specific. In conclusion, automated planning with integrated BAO can further enhance and individualize radiotherapy for LA-NSCLC.
在本研究中，开发了用于自动多标准规划并集成射束角度优化（BAO）的新型iCE放射治疗治疗计划系统（TPS），并将其应用于优化危及器官（OAR）的保护，并系统地研究射束角度对局部晚期非小细胞肺癌（LA-NSCLC）放射治疗剂量的影响。iCE由一个内部复杂的集成BAO的多标准优化器与一个广泛使用的商业TPS组成。内部优化器执行通量图优化，为每位患者自动生成具有最佳射束角度的调强放射治疗（IMRT）计划。然后，将获得的角度和剂量体积直方图用于通过商业TPS自动生成最终可交付计划。对于26例LA-NSCLC患者中的大多数，与手动创建的临床计划相比，iCE实现了更好的心脏和食管保护，中位心脏D（8.1 vs. 9.0 Gy，P = 0.02）和食管D（18.5 vs. 20.3 Gy，P = 0.02）显著降低，个别患者降低多达6.7 Gy和5.8 Gy。iCE优于使用手动选择射束角度的自动规划。iCE计划中6束射束与4束和8束射束相比，OAR剂量的差异总体上具有统计学意义，但高度因人而异。总之，集成BAO的自动规划可以进一步增强LA-NSCLC的放射治疗并实现个体化。
