Evaluation of a generalized knowledge-based planning performance for VMAT irradiation of breast and locoregional lymph nodes—Internal mammary and/or supraclavicular regions
Open Access
- 15 January 2021
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 16 (1), e0245305
- https://doi.org/10.1371/journal.pone.0245305
Abstract
To evaluate the performance of eleven Knowledge-Based (KB) models for planning optimization (RapidPlantm (RP), Varian) of Volumetric Modulated Arc Therapy (VMAT) applied to whole breast comprehensive of nodal stations, internal mammary and/or supraclavicular regions. Six RP models have been generated and trained based on 120 VMAT plans data set with different criteria. Two extra-structures were delineated: a PTV for the optimization and a ring structure. Five more models, twins of the previous models, have been created without the need of these structures. All models were successfully validated on an independent cohort of 40 patients, 30 from the same institute that provided the training patients and 10 from an additional institute, with the resulting plans being of equal or better quality compared with the clinical plans. The internal validation shows that the models reduce the heart maximum dose of about 2 Gy, the mean dose of about 1 Gy and the V20Gy of 1.5 Gy on average. Model R and L together with model B without optimization structures ensured the best outcomes in the 20% of the values compared to other models. The external validation observed an average improvement of at least 16% for the V5Gy of lungs in RP plans. The mean heart dose and for the V20Gy for lung IPSI were almost halved. The models reduce the maximum dose for the spinal canal of more than 2 Gy on average All KB models allow a homogeneous plan quality and some dosimetric gains, as we saw in both internal and external validation. Sub-KB models, developed by splitting right and left breast cases or including only whole breast with locoregional lymph nodes, have shown good performances, comparable but slightly worse than the general model. Finally, models generated without the optimization structures, performed better than the original ones.This publication has 76 references indexed in Scilit:
- Improved heart, lung and target dose with deep inspiration breath hold in a large clinical series of breast cancer patientsRadiotherapy and Oncology, 2013
- Quantitative analysis of the factors which affect the interpatient organ‐at‐risk dose sparing variation in IMRT plansMedical Physics, 2012
- Inter‐ and intra‐fraction motion during radiation therapy to the whole breast in the supine position: A systematic reviewJournal of Medical Imaging and Radiation Oncology, 2012
- Phase I-II study of hypofractionated simultaneous integrated boost using volumetric modulated arc therapy for adjuvant radiation therapy in breast cancer patients: a report of feasibility and early toxicity results in the first 50 treatmentsRadiation Oncology, 2012
- Radiation during deep inspiration allows loco-regional treatment of left breast and axillary-, supraclavicular- and internal mammary lymph nodes without compromising target coverage or dose restrictions to organs at riskActa Oncologica, 2011
- Volumetric modulated arc therapy: a review of current literature and clinical use in practiceThe British Journal of Radiology, 2011
- Dosimetric evaluation of Acuros XB Advanced Dose Calculation algorithm in heterogeneous mediaRadiation Oncology, 2011
- Clinical Results of Image-Guided Deep Inspiration Breath Hold Breast IrradiationInternational Journal of Radiation Oncology*Biology*Physics, 2010
- Pre-clinical evaluation of respiratory-gated delivery of volumetric modulated arc therapy with RapidArcPhysics in Medicine & Biology, 2010
- Simultaneous integrated boost radiotherapy for bilateral breast: a treatment planning and dosimetric comparison for volumetric modulated arc and fixed field intensity modulated therapyRadiation Oncology, 2009