Fully automated VMAT treatment planning for advanced-stage NSCLC patients

• Published in: Strahlentherapie und Onkologie Vol. 193; no. 5; pp. 402 - 409
• Main Authors: Della Gala, Giuseppe, Dirkx, Maarten L. P., Hoekstra, Nienke, Fransen, Dennie, Lanconelli, Nico, van de Pol, Marjan, Heijmen, Ben J. M., Petit, Steven F.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2017; Springer Nature B.V
• Subjects: Algorithms; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Humans; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Medicine; Medicine & Public Health; Neoplasm Staging; Oncology; Organs at Risk - radiation effects; Original; Original Article; Radiotherapy; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted - methods; Radiotherapy, Intensity-Modulated - methods; Reproducibility of Results; Sensitivity and Specificity; Software; Treatment Outcome; Tumor Burden - radiation effects; User-Computer Interface; Vollautomatisierte Strahlentherapieplanung; Risikoorgane; Volumetric-modulated arc therapy; Nicht-kleinzelliges Bronchialkarzinom; Radiotherapy, intensity-modulated; Non-small cell lung carcinoma; Organs at risk; Intensitätsmodulierte Strahlentherapie; Volumenmodulierte Arc Therapie; Computer-assisted radiotherapy planning
• ISSN: 0179-7158; 1439-099X; 1439-099X
• DOI: 10.1007/s00066-017-1121-1

Purpose To develop a fully automated procedure for multicriterial volumetric modulated arc therapy (VMAT) treatment planning (autoVMAT) for stage III/IV non-small cell lung cancer (NSCLC) patients treated with curative intent. Materials and methods After configuring the developed autoVMAT system for NSCLC, autoVMAT plans were compared with manually generated clinically delivered intensity-modulated radiotherapy (IMRT) plans for 41 patients. AutoVMAT plans were also compared to manually generated VMAT plans in the absence of time pressure. For 16 patients with reduced planning target volume (PTV) dose prescription in the clinical IMRT plan (to avoid violation of organs at risk tolerances), the potential for dose escalation with autoVMAT was explored. Results Two physicians evaluated 35/41 autoVMAT plans (85%) as clinically acceptable. Compared to the manually generated IMRT plans, autoVMAT plans showed statistically significant improved PTV coverage (V 95% increased by 1.1% ± 1.1%), higher dose conformity (R 50 reduced by 12.2% ± 12.7%), and reduced mean lung, heart, and esophagus doses (reductions of 0.9 Gy ± 1.0 Gy, 1.5 Gy ± 1.8 Gy, 3.6 Gy ± 2.8 Gy, respectively, all p  < 0.001). To render the six remaining autoVMAT plans clinically acceptable, a dosimetrist needed less than 10 min hands-on time for fine-tuning. AutoVMAT plans were also considered equivalent or better than manually optimized VMAT plans. For 6/16 patients, autoVMAT allowed tumor dose escalation of 5–10 Gy. Conclusion Clinically deliverable, high-quality autoVMAT plans can be generated fully automatically for the vast majority of advanced-stage NSCLC patients. For a subset of patients, autoVMAT allowed for tumor dose escalation.