Pogue Joel A, Cardenas Carlos E, Cao Yanan, Popple Richard A, Soike Michael, Boggs Drexell Hunter, Stanley Dennis N, Harms Joseph
Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States.
Front Oncol. 2023 Feb 10;13:1130119. doi: 10.3389/fonc.2023.1130119. eCollection 2023.
Accelerated partial breast irradiation (APBI) yields similar rates of recurrence and cosmetic outcomes as compared to whole breast radiation therapy (RT) when patients and treatment techniques are appropriately selected. APBI combined with stereotactic body radiation therapy (SBRT) is a promising technique for precisely delivering high levels of radiation while avoiding uninvolved breast tissue. Here we investigate the feasibility of automatically generating high quality APBI plans in the Ethos adaptive workspace with a specific emphasis on sparing the heart.
Nine patients (10 target volumes) were utilized to iteratively tune an Ethos APBI planning template for automatic plan generation. Twenty patients previously treated on a TrueBeam Edge accelerator were then automatically replanned using this template without manual intervention or reoptimization. The unbiased validation cohort Ethos plans were benchmarked adherence to planning objectives, a comparison of DVH and quality indices against the clinical Edge plans, and qualitative reviews by two board-certified radiation oncologists.
85% (17/20) of automated validation cohort plans met all planning objectives; three plans did not achieve the contralateral lung V1.5Gy objective, but all other objectives were achieved. Compared to the Eclipse generated plans, the proposed Ethos template generated plans with greater evaluation planning target volume (PTV_Eval) V100% coverage ( = 0.01), significantly decreased heart V1.5Gy (< 0.001), and increased contralateral breast V5Gy, skin D0.01cc, and RTOG conformity index ( = 0.03, = 0.03, and = 0.01, respectively). However, only the reduction in heart dose was significant after correcting for multiple testing. Physicist-selected plans were deemed clinically acceptable without modification for 75% and 90% of plans by physicians A and B, respectively. Physicians A and B scored at least one automatically generated plan as clinically acceptable for 100% and 95% of planning intents, respectively.
Standard left- and right-sided planning templates automatically generated APBI plans of comparable quality to manually generated plans treated on a stereotactic linear accelerator, with a significant reduction in heart dose compared to Eclipse generated plans. The methods presented in this work elucidate an approach for generating automated, cardiac-sparing APBI treatment plans for daily adaptive RT with high efficiency.
当患者和治疗技术被适当选择时，与全乳放疗（RT）相比，加速部分乳腺照射（APBI）产生相似的复发率和美容效果。APBI联合立体定向体部放疗（SBRT）是一种有前景的技术，可精确给予高剂量辐射，同时避免未受累的乳腺组织。在此，我们研究在Ethos自适应工作空间中自动生成高质量APBI计划的可行性，特别强调保护心脏。
利用9名患者（10个靶区体积）迭代调整Ethos APBI计划模板以进行自动计划生成。然后，对20名先前在TrueBeam Edge加速器上接受治疗的患者使用该模板进行自动重新计划，无需人工干预或重新优化。将无偏验证队列的Ethos计划在符合计划目标方面进行基准测试，将剂量体积直方图（DVH）和质量指标与临床Edge计划进行比较，并由两名获得董事会认证的放射肿瘤学家进行定性审查。
85%（17/20）的自动验证队列计划符合所有计划目标；三个计划未达到对侧肺V1.5Gy目标，但实现了所有其他目标。与Eclipse生成的计划相比，所提出的Ethos模板生成的计划具有更高的评估计划靶区体积（PTV_Eval）V100%覆盖率（P = 0.01），心脏V1.5Gy显著降低（P < 0.001），对侧乳腺V5Gy、皮肤D0.01cc和RTOG适形指数增加（分别为P = 0.03、P = 0.03和P = 0.01）。然而，在进行多重检验校正后，只有心脏剂量的降低具有显著性。物理学家选择的计划分别被医生A和医生B认为75%和90%的计划无需修改在临床上是可接受的。医生A和医生B分别将至少一个自动生成的计划评为100%和95%的计划意图在临床上是可接受的。
标准的左侧和右侧计划模板自动生成的APBI计划质量与在立体定向直线加速器上手动生成的计划相当，与Eclipse生成的计划相比，心脏剂量显著降低。这项工作中提出的方法阐明了一种为日常自适应放疗高效生成自动、保护心脏的APBI治疗计划的方法。
