Department of Radiation Oncology, University of Southern California and Children's Hospital Los Angeles, Los Angeles, California.
Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, Illinois.
Pract Radiat Oncol. 2023 Jul-Aug;13(4):e374-e382. doi: 10.1016/j.prro.2023.02.008. Epub 2023 Apr 9.
This study evaluates the quality of plans used for the treatment of patients in the Children's Oncology Group study ACNS1123. Plan quality is quantified based on a scoring system specific to the protocol. In this way, the distribution of plan quality scores is determined that can be used to identify plan quality issues for this study and for future plan quality improvement.
ACNS1123 stratum 1 patients (70) were evaluated. This included 50 photon and 20 proton plans. Digital Imaging and Communications in Medicine (DICOM) structure and dose data were obtained from the Children's Oncology Group. A commercially available plan quality scoring algorithm was used to create a scoring system we designed using the protocol dosimetric requirements. The whole ventricle and boost planning target volumes (PTVs) could earn a maximum of 70 points, whereas the organs at risk could earn 30 points (total maximum score of 100 points). The scoring algorithm adjusted scores based on the difficulty in achieving the structure dose requirements, which depended on the proximity of the PTVs and the dose gradients achieved relative to the organs at risk. The distribution of plan scores was used to determine the mean, median, and range of scores.
The median adjusted plan quality scores for the 20 proton and 50 photon plans were 83.3 and 86.9, respectively. The range of adjusted scores (maximum to minimum) was 50 points. The average score adjustment was 7.4 points. Photon and proton plans performed almost equally. Average plan quality by individual structure revealed that the brain stem, PTV boost, and cochlea lost the most points.
This report is the first to systematically analyze overall radiation therapy plan quality scores for an entire cohort of patients treated in a cooperative group clinical trial. The methodology demonstrated a large variation in plan quality in this trial. Future clinical trials could potentially use this method to reduce plan quality variability, which may improve outcomes.
本研究评估了儿童肿瘤学组研究 ACNS1123 中患者治疗计划的质量。根据特定于方案的评分系统来量化计划质量。通过这种方式，可以确定计划质量得分的分布情况，用于识别本研究和未来计划质量改进中的计划质量问题。
评估了 ACNS1123 分层 1 患者（70 例）。这包括 50 例光子和 20 例质子计划。数字成像和通信在医学（DICOM）结构和剂量数据是从儿童肿瘤学组获得的。使用商业上可获得的计划质量评分算法，我们使用协议剂量学要求设计了一个评分系统。整个脑室和增强靶区（PTV）最高可获得 70 分，而危及器官最高可获得 30 分（总分 100 分）。评分算法根据实现结构剂量要求的难度调整分数，这取决于 PTV 的接近程度和相对于危及器官实现的剂量梯度。计划评分的分布用于确定评分的平均值、中位数和范围。
20 例质子和 50 例光子计划的中位数调整后计划质量评分分别为 83.3 和 86.9。调整后评分范围（最高分至最低分）为 50 分。平均评分调整为 7.4 分。光子和质子计划的表现几乎相同。按单个结构计算的平均计划质量表明，脑干、PTV 增强和耳蜗失去了最多的分数。
本报告首次系统分析了合作组临床试验中整个患者队列的整体放射治疗计划质量评分。该方法在该试验中显示了计划质量的很大差异。未来的临床试验可能会使用这种方法来减少计划质量的变异性，这可能会改善结果。
