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

Phys Med. 2024 Jul:123:103394. doi: 10.1016/j.ejmp.2024.103394. Epub 2024 Jun 8.

Authors

C Fiandra¹, S Zara², V Richetto³, L Rossi⁴, M C Leonardi⁵, P Ferrari⁶, M Marrocco⁷, E Gino⁸, S Cora⁹, G Loi¹⁰, F Rosica¹¹, S Ren Kaiser¹², E Verdolino¹³, L Strigari¹⁴, N Romeo¹⁵, L Placidi¹⁶, S Comi¹⁷, G De Otto¹⁸, A Roggio¹⁹, A Di Dio³, L Reversi²⁰, E Pierpaoli²¹, E Infusino²², E Coeli²³, T Licciardello²⁴, A Ciarmatori²⁵, R Caivano²⁶, A Poggiu²⁷, N Ciscognetti²⁸, U Ricardi²⁹, B Heijmen⁴

Affiliations

¹ University of Turin, Department of Oncology, Turin, Italy. Electronic address: christian.fiandra@unito.it.
² Tecnologie Avanzate, Turin, Italy.
³ Medical Physics Unit, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.
⁴ Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
⁵ Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
⁶ Department of Health Physics, Provincial Hospital of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano-Bozen, Italy.
⁷ Radiation Oncology, Campus Biomedico University, Rome, Italy.
⁸ SC Fisica Sanitaria AO Ordine Mauriziano di Torino, Turin, Italy.
⁹ U.O.C. Fisica Sanitaria, Ospedale "San Bortolo", AULSS8, Vicenza, Italy.
¹⁰ Department of Medical Physics, 'Maggiore della Carità' University Hospital, Novara, Italy.
¹¹ U.O.C. Fisica Sanitaria, ASL Teramo, Italy.
¹² S.C. Fisica Sanitaria, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy.
¹³ Ospedale S. G. MOSCATI, Taranto, Italy.
¹⁴ Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
¹⁵ UOC Radioterapia. Azienda Sanitaria Provinciale di Messina. Ospedale "San Vincenzo", Taormina, Italy.
¹⁶ Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
¹⁷ Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy.
¹⁸ S.C. Fisica Sanitaria Firenze-Empoli Azienda USL Toscana Centro, Italy.
¹⁹ Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.
²⁰ Ospedali Riuniti di Ancona - Medical Physics Department, Ancona, Italy.
²¹ UOC Fisica Sanitaria, Area Vasta 5 Asur P.O. Mazzoni, Ascoli, Italy.
²² Medical Physics Dept IRCCS Regina Elena National Cancer Institute, Rome.
²³ U.O.C. di RADIOTERAPIA Azienda ULSS 9 Scaligera del Veneto, Legnago (VR), Italy.
²⁴ SC Fisica Sanitaria, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy.
²⁵ UOC Fisica Medica e Alte Tecnologie, AST Pesaro Urbino, Pesaro, Italy.
²⁶ UOC di Radioterapia Oncologica e Fisica Sanitaria, IRCCS CROB Rionero in Vulture, Potenza, Italy.
²⁷ SSD Fisica Sanitaria AOU Sassari, Italy.
²⁸ ASL2 liguria - Dipartimento di diagnostic, SSD fisica sanitaria, Savona, Italy.
²⁹ University of Turin, Department of Oncology, Turin, Italy.

PMID: 38852364
DOI: 10.1016/j.ejmp.2024.103394

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 D_mean, 16.7 % for ipsilateral lung D_mean, and 101.9 %, 45.5 %, and 35.7 % for contralateral breast D_0.03cc, D_5% and D_mean, 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: Boost and elective nodes; Multi-center autoplanning validation; Whole breast radiotherapy.

Publication types

Multicenter Study
Validation Study

MeSH terms

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