Multi-centre real-world validation of automated treatment planning for breast radiotherapy

C Fiandra; S Zara; V Richetto; L Rossi; M C Leonardi; P Ferrari; M Marrocco; E Gino; S Cora; G Loi; F Rosica; S Ren Kaiser; E Verdolino; L Strigari; N Romeo; L Placidi; S Comi; G De Otto; A Roggio; A Di Dio; L Reversi; E Pierpaoli; E Infusino; E Coeli; T Licciardello; A Ciarmatori; R Caivano; A Poggiu; N Ciscognetti; U Ricardi; B Heijmen

doi:10.1016/j.ejmp.2024.103394

Multi-centre real-world validation of automated treatment planning for breast radiotherapy

C Fiandra
, S Zara
, V Richetto
, L Rossi
, M C Leonardi
, P Ferrari
, M Marrocco
, E Gino
, S Cora
, G Loi
, F Rosica
, S Ren Kaiser
, E Verdolino
, L Strigari
, N Romeo
, L Placidi
, S Comi
, G De Otto
, A Roggio
, A Di Dio

L Reversi, E Pierpaoli, E Infusino, E Coeli, T Licciardello, A Ciarmatori, R Caivano, A Poggiu, N Ciscognetti, U Ricardi, B Heijmen

Krankenhaus Bozen

Tecnologie Avanzate
Medical Physics Unit
University Medical Center Rotterdam
IEO European Institute of Experimental Oncology IRCCS
Provincial Hospital of Bolzano (SABES-ASDAA)
Campus Biomedico University
SC Fisica Sanitaria AO Ordine Mauriziano di Torino
U.O.C. Fisica Sanitaria
University Maggiore Hospital Della Carità
S.C. Fisica Sanitaria
Ospedale S. G. MOSCATI
Department of Physiology and Medical Physics
UOC Radioterapia. Azienda Sanitaria Provinciale di Messina. Ospedale "San Vincenzo"
Istituto Tumori Milano + Fondazione Policlinico Universitario A Gemelli IRCCS
European Institute of Oncology IRCCS
S.C. Fisica Sanitaria Firenze-Empoli Azienda USL Toscana Centro
Veneto Institute of Oncology IOV-IRCCS
Ospedali Riuniti di Ancona - Medical Physics Department
UOC Fisica Sanitaria
Medical Physics Dept IRCCS Regina Elena National Cancer Institute
Legnago (VR)
SC Fisica Sanitaria
UOC Fisica Medica e Alte Tecnologie
UOC di Radioterapia Oncologica e Fisica Sanitaria
SSD Fisica Sanitaria AOU Sassari
SSD fisica sanitaria

Publikation: Beitrag in Fachzeitschrift › Originalarbeit › Begutachtung

Abstract

PURPOSE: To present the results of the first multi-centre real-world validation of autoplanning for whole breast irradiation after breast-sparing surgery, encompassing high complexity cases (e.g. with a boost or regional lymph nodes) and a wide range of clinical practices.

METHODS: The 24 participating centers each included 10 IMRT/VMAT/Tomotherapy patients, previously treated with a manually generated plan ('manplan'). There were no restrictions regarding case complexity, planning aims, plan evaluation parameters and criteria, fractionation, treatment planning system or treatment machine/technique. In addition to dosimetric comparisons of autoplans with manplans, blinded plan scoring/ranking was conducted by a clinician from the treating center. Autoplanning was performed using a single configuration for all patients in all centres. Deliverability was verified through measurements at delivery units.

RESULTS: Target dosimetry showed comparability, while reductions in OAR dose parameters were 21.4 % for heart Dmean, 16.7 % for ipsilateral lung Dmean, and 101.9 %, 45.5 %, and 35.7 % for contralateral breast D0.03cc, D5% and Dmean, respectively (all p < 0.001). Among the 240 patients included, the clinicians preferred the autoplan for 119 patients, with manplans preferred for 96 cases (p = 0.01). Per centre there were on average 5.0 ± 2.9 (1SD) patients with a preferred autoplan (range [0-10]), compared to 4.0 ± 2.7 with a preferred manplan ([0,9]). No differences were observed regarding deliverability.

CONCLUSION: The automation significantly reduced the hands-on planning workload compared to manual planning, while also achieving an overall superiority. However, fine-tuning of the autoplanning configuration prior to clinical implementation may be necessary in some centres to enhance clinicians' satisfaction with the generated autoplans.

Originalsprache	Englisch
Seiten (von - bis)	103394
Fachzeitschrift	Physica Medica: European Journal of Medical Physics
Jahrgang	123
DOIs	https://doi.org/10.1016/j.ejmp.2024.103394
Publikationsstatus	Veröffentlicht - Juli 2024

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10.1016/j.ejmp.2024.103394

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Fiandra, C., Zara, S., Richetto, V., Rossi, L., Leonardi, M. C., Ferrari, P., Marrocco, M., Gino, E., Cora, S., Loi, G., Rosica, F., Ren Kaiser, S., Verdolino, E., Strigari, L., Romeo, N., Placidi, L., Comi, S., De Otto, G., Roggio, A., ... Heijmen, B. (2024). Multi-centre real-world validation of automated treatment planning for breast radiotherapy. Physica Medica: European Journal of Medical Physics, 123, 103394. https://doi.org/10.1016/j.ejmp.2024.103394

@article{20701ed7d45b4d47b6a5f360df46cb67,

title = "Multi-centre real-world validation of automated treatment planning for breast radiotherapy",

abstract = "PURPOSE: To present the results of the first multi-centre real-world validation of autoplanning for whole breast irradiation after breast-sparing surgery, encompassing high complexity cases (e.g. with a boost or regional lymph nodes) and a wide range of clinical practices.METHODS: The 24 participating centers each included 10 IMRT/VMAT/Tomotherapy patients, previously treated with a manually generated plan ('manplan'). There were no restrictions regarding case complexity, planning aims, plan evaluation parameters and criteria, fractionation, treatment planning system or treatment machine/technique. In addition to dosimetric comparisons of autoplans with manplans, blinded plan scoring/ranking was conducted by a clinician from the treating center. Autoplanning was performed using a single configuration for all patients in all centres. Deliverability was verified through measurements at delivery units.RESULTS: Target dosimetry showed comparability, while reductions in OAR dose parameters were 21.4 \% for heart Dmean, 16.7 \% for ipsilateral lung Dmean, and 101.9 \%, 45.5 \%, and 35.7 \% for contralateral breast D0.03cc, D5\% and Dmean, respectively (all p < 0.001). Among the 240 patients included, the clinicians preferred the autoplan for 119 patients, with manplans preferred for 96 cases (p = 0.01). Per centre there were on average 5.0 ± 2.9 (1SD) patients with a preferred autoplan (range [0-10]), compared to 4.0 ± 2.7 with a preferred manplan ([0,9]). No differences were observed regarding deliverability.CONCLUSION: The automation significantly reduced the hands-on planning workload compared to manual planning, while also achieving an overall superiority. However, fine-tuning of the autoplanning configuration prior to clinical implementation may be necessary in some centres to enhance clinicians' satisfaction with the generated autoplans.",

keywords = "Radiotherapy Planning, Computer-Assisted/methods, Humans, Breast Neoplasms/radiotherapy, Automation, Radiotherapy, Intensity-Modulated/methods, Organs at Risk/radiation effects, Radiotherapy Dosage, Female, Radiometry",

author = "C Fiandra and S Zara and V Richetto and L Rossi and Leonardi, \{M C\} and P Ferrari and M Marrocco and E Gino and S Cora and G Loi and F Rosica and \{Ren Kaiser\}, S and E Verdolino and L Strigari and N Romeo and L Placidi and S Comi and \{De Otto\}, G and A Roggio and \{Di Dio\}, A and L Reversi and E Pierpaoli and E Infusino and E Coeli and T Licciardello and A Ciarmatori and R Caivano and A Poggiu and N Ciscognetti and U Ricardi and B Heijmen",

note = "Department of Health Physics, Provincial Hospital of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversit{\"a}t, Bolzano-Bozen, Italy",

year = "2024",

month = jul,

doi = "10.1016/j.ejmp.2024.103394",

language = "English",

volume = "123",

pages = "103394",

journal = "Physica Medica: European Journal of Medical Physics",

issn = "1120-1797",

}

Fiandra, C, Zara, S, Richetto, V, Rossi, L, Leonardi, MC, Ferrari, P, Marrocco, M, Gino, E, Cora, S, Loi, G, Rosica, F, Ren Kaiser, S, Verdolino, E, Strigari, L, Romeo, N, Placidi, L, Comi, S, De Otto, G, Roggio, A, Di Dio, A, Reversi, L, Pierpaoli, E, Infusino, E, Coeli, E, Licciardello, T, Ciarmatori, A, Caivano, R, Poggiu, A, Ciscognetti, N, Ricardi, U & Heijmen, B 2024, 'Multi-centre real-world validation of automated treatment planning for breast radiotherapy', Physica Medica: European Journal of Medical Physics, Jg. 123, S. 103394. https://doi.org/10.1016/j.ejmp.2024.103394

TY - JOUR

T1 - Multi-centre real-world validation of automated treatment planning for breast radiotherapy

AU - Fiandra, C

AU - Zara, S

AU - Richetto, V

AU - Rossi, L

AU - Leonardi, M C

AU - Ferrari, P

AU - Marrocco, M

AU - Gino, E

AU - Cora, S

AU - Loi, G

AU - Rosica, F

AU - Ren Kaiser, S

AU - Verdolino, E

AU - Strigari, L

AU - Romeo, N

AU - Placidi, L

AU - Comi, S

AU - De Otto, G

AU - Roggio, A

AU - Di Dio, A

AU - Reversi, L

AU - Pierpaoli, E

AU - Infusino, E

AU - Coeli, E

AU - Licciardello, T

AU - Ciarmatori, A

AU - Caivano, R

AU - Poggiu, A

AU - Ciscognetti, N

AU - Ricardi, U

AU - Heijmen, B

N1 - Department of Health Physics, Provincial Hospital of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano-Bozen, Italy

PY - 2024/7

Y1 - 2024/7

N2 - PURPOSE: To present the results of the first multi-centre real-world validation of autoplanning for whole breast irradiation after breast-sparing surgery, encompassing high complexity cases (e.g. with a boost or regional lymph nodes) and a wide range of clinical practices.METHODS: The 24 participating centers each included 10 IMRT/VMAT/Tomotherapy patients, previously treated with a manually generated plan ('manplan'). There were no restrictions regarding case complexity, planning aims, plan evaluation parameters and criteria, fractionation, treatment planning system or treatment machine/technique. In addition to dosimetric comparisons of autoplans with manplans, blinded plan scoring/ranking was conducted by a clinician from the treating center. Autoplanning was performed using a single configuration for all patients in all centres. Deliverability was verified through measurements at delivery units.RESULTS: Target dosimetry showed comparability, while reductions in OAR dose parameters were 21.4 % for heart Dmean, 16.7 % for ipsilateral lung Dmean, and 101.9 %, 45.5 %, and 35.7 % for contralateral breast D0.03cc, D5% and Dmean, respectively (all p < 0.001). Among the 240 patients included, the clinicians preferred the autoplan for 119 patients, with manplans preferred for 96 cases (p = 0.01). Per centre there were on average 5.0 ± 2.9 (1SD) patients with a preferred autoplan (range [0-10]), compared to 4.0 ± 2.7 with a preferred manplan ([0,9]). No differences were observed regarding deliverability.CONCLUSION: The automation significantly reduced the hands-on planning workload compared to manual planning, while also achieving an overall superiority. However, fine-tuning of the autoplanning configuration prior to clinical implementation may be necessary in some centres to enhance clinicians' satisfaction with the generated autoplans.

AB - PURPOSE: To present the results of the first multi-centre real-world validation of autoplanning for whole breast irradiation after breast-sparing surgery, encompassing high complexity cases (e.g. with a boost or regional lymph nodes) and a wide range of clinical practices.METHODS: The 24 participating centers each included 10 IMRT/VMAT/Tomotherapy patients, previously treated with a manually generated plan ('manplan'). There were no restrictions regarding case complexity, planning aims, plan evaluation parameters and criteria, fractionation, treatment planning system or treatment machine/technique. In addition to dosimetric comparisons of autoplans with manplans, blinded plan scoring/ranking was conducted by a clinician from the treating center. Autoplanning was performed using a single configuration for all patients in all centres. Deliverability was verified through measurements at delivery units.RESULTS: Target dosimetry showed comparability, while reductions in OAR dose parameters were 21.4 % for heart Dmean, 16.7 % for ipsilateral lung Dmean, and 101.9 %, 45.5 %, and 35.7 % for contralateral breast D0.03cc, D5% and Dmean, respectively (all p < 0.001). Among the 240 patients included, the clinicians preferred the autoplan for 119 patients, with manplans preferred for 96 cases (p = 0.01). Per centre there were on average 5.0 ± 2.9 (1SD) patients with a preferred autoplan (range [0-10]), compared to 4.0 ± 2.7 with a preferred manplan ([0,9]). No differences were observed regarding deliverability.CONCLUSION: The automation significantly reduced the hands-on planning workload compared to manual planning, while also achieving an overall superiority. However, fine-tuning of the autoplanning configuration prior to clinical implementation may be necessary in some centres to enhance clinicians' satisfaction with the generated autoplans.

KW - Radiotherapy Planning, Computer-Assisted/methods

KW - Humans

KW - Breast Neoplasms/radiotherapy

KW - Automation

KW - Radiotherapy, Intensity-Modulated/methods

KW - Organs at Risk/radiation effects

KW - Radiotherapy Dosage

KW - Female

KW - Radiometry

U2 - 10.1016/j.ejmp.2024.103394

DO - 10.1016/j.ejmp.2024.103394

M3 - Original Article

C2 - 38852364

SN - 1120-1797

VL - 123

SP - 103394

JO - Physica Medica: European Journal of Medical Physics

JF - Physica Medica: European Journal of Medical Physics

ER -

Multi-centre real-world validation of automated treatment planning for breast radiotherapy

Abstract

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