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. 2021 May 26:18:61-67.
doi: 10.1016/j.phro.2021.05.004. eCollection 2021 Apr.

Development and clinical validation of Knowledge-based planning for Volumetric Modulated Arc Therapy of cervical cancer including pelvic and para aortic fields

Jamema Swamidas  1   2   3 , Sangram Pradhan  4   3 , Supriya Chopra  1   2   3 , Subhajit Panda  1   2   3 , Yashna Gupta  5   3 , Sahil Sood  2   6   3 , Samarpita Mohanty  2   6   3 , Jeevanshu Jain  1   2   3 , Kishore Joshi  1   2   3 , Reena Ph  1   2   3 , Lavanya Gurram  2   6   3 , Umesh Mahantshetty  2   7   3 , Jai Prakash Agarwal  2   6   3
Affiliations

Development and clinical validation of Knowledge-based planning for Volumetric Modulated Arc Therapy of cervical cancer including pelvic and para aortic fields

Jamema Swamidas et al. Phys Imaging Radiat Oncol. .

Abstract

Background and purpose: Knowledge-based planning (KBP) is based on a model to estimate dose-volume histograms, configured using a library of historical treatment plans to efficiently create high quality plans. The aim was to report configuration and validation of KBP for Volumetric Modulated Arc Therapy of cervical cancer.

Materials and methods: A KBP model was configured from the institutional database (n = 125), including lymph node positive (n = 60) and negative (n = 65) patients. KBP Predicted plans were compared with Clinical Plans (CP) and Re-plans (Predicted plan as a base-plan) to validate the model. Model quality was quantified using coefficient of determination R2, mean square error (MSE), standard two-tailed paired t-test and Wilcoxon signed rank test.

Results: Estimation capability of the model was good for the bowel bag (MSE = 0.001, R2 = 0.84), modest for the bladder (MSE = 0.008) and poor for the rectum (MSE = 0.02 R2 = 0.78). KBP resulted in comparable target coverage, superior organ sparing as compared to CP. Re-plans outperformed CP for the bladder, V30 (66 ± 11% vs 74 ± 11%, p < .001), V40 (48 ± 14% vs 52 ± 14%, p < .001), however sparing was modest for the bowel bag V30 (413 ± 191cm3 vs 445 ± 208cm3, p = .037) V40 (199 ± 105cm3 vs 218 ± 127cm3, p = .031). All plans were comparable for rectum, while KBP resulted in significant sparing for spinal cord, kidneys and femoral heads.

Conclusion: KBP yielded comparable and for some organs superior performance compared to CP resulting in conformal and homogeneous target coverage. Improved organ sparing was observed when individual patient geometry was considered.

Keywords: Cervix cancer; Knowledge-based planning.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Regression plot and estimation band of the model. a. Regression plot of bowel bag, b. Regression plot of bladder, c. Representative estimation band for bowel bag with dose-volume histogram obtained by predicted plan, d. Representative estimation band for bladder with dose-volume histogram obtained by predicted plan, the proportion of overlap volume is indicated as a broad band at the high dose region in c and d.
Fig. 2
Fig. 2
Average dose volume histogram comparison of clinical plan, Predicted plan and Replan for various organs at risks.
Fig. 3
Fig. 3
A representative qualitative comparison of dose distribution of clinical plans and Knowledge based Re-plans.
See this image and copyright information in PMC

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