立体定向体部放疗用于肺癌时的自动计划

Autoplanning in the setting of stereotactic body radiation therapy for lung cancer.

作者信息

Infusino Erminia, Ianiro Anna, D'Andrea Marco, Zara Stefania, Landoni Valeria, Dionisi Francesco, Sperati Francesca, Quagliani Francesco, Soriani Antonella, Fiandra Christian

机构信息

Medical Physics Department. IRCCS Regina Elena National Cancer Institute - IFO, Rome, Italy.

出版信息

Phys Med. 2025 Feb;130:104902. doi: 10.1016/j.ejmp.2025.104902. Epub 2025 Jan 17.

DOI:10.1016/j.ejmp.2025.104902

PMID:39826467

Abstract

PURPOSE

Automatic planning (AP) has been compared to manual planning (MP) in lung stereotactic body radiation therapy (SBRT) to validate the former and to implement it in clinical practice.

METHODS

A new developing Guided Planning System (GPS) engine was used to reoptimize 20 lung SBRT plans with the RayStation™ treatment planning system (TPS). The original manual plans were optimized to deliver 60 Gy in 5 or 8 fractions to the target with constraints on organs at risk (OARs) based on an internal protocol. AP plans were compared to MP based on (i) planning target volume (PTV) and OARs dosimetric evaluation, (ii) clinician's blind plan comparison, (iii) Plan QA results, and (iv) plan quality metrics. Differences between continuous variables were explored through the Mann-Whitney test (p < 0.05).

RESULTS

Target and OARs dosimetry showed no significant difference, with the only exception of the spinal cord maximum dose that was significantly lower for AP in the 5 fractions scheme (MP: 8.93 Gy ± 3.94 Gy vs AP: 6.45 Gy ± 2.72 Gy, p = 0.034). In the blind comparison, AP was preferred in 45 % of cases while MP in 35 % of cases (no preference was expressed in 20 % of cases). A trend towards lower monitor units (MUs) was found for AP in the 5 fractions scheme (MP: 3383 ± 943 vs AP: 2662 ± 588, p = 0.059). No significant difference was found in any of the plan quality metrics.

CONCLUSIONS

AP plans were not inferior to MP plans; therefore, GPS is ready for clinical use in a pulmonary SBRT setting, reducing the planning workload and harmonizing the planning procedure.

摘要

目的

在肺部立体定向体部放射治疗（SBRT）中，将自动计划（AP）与手动计划（MP）进行比较，以验证前者并将其应用于临床实践。

方法

使用一种新开发的引导计划系统（GPS）引擎，通过RayStation™治疗计划系统（TPS）对20例肺部SBRT计划进行重新优化。根据内部协议，将原始手动计划优化为在5或8次分割中向靶区给予60 Gy剂量，并对危及器官（OAR）进行限制。基于以下方面将AP计划与MP计划进行比较：（i）计划靶区体积（PTV）和OAR剂量学评估；（ii）临床医生的盲法计划比较；（iii）计划质量保证（QA）结果；（iv）计划质量指标。通过曼-惠特尼检验探索连续变量之间的差异（p < 0.05）。

结果

靶区和OAR剂量学显示无显著差异，唯一的例外是在5次分割方案中脊髓最大剂量，AP组显著更低（MP：8.93 Gy ± 3.94 Gy vs AP：6.45 Gy ± 2.72 Gy，p = 0.034）。在盲法比较中，45%的病例中AP更受青睐，35%的病例中MP更受青睐（20%的病例未表达偏好）。在5次分割方案中发现AP有较低监测单位（MU）的趋势（MP：3383 ± 943 vs AP：2662 ± 588，p = 0.059）。在任何计划质量指标中均未发现显著差异。