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Multicenter Study
. 2024 Jul:123:103394.
doi: 10.1016/j.ejmp.2024.103394. Epub 2024 Jun 8.

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

C Fiandra  1 , S Zara  2 , V Richetto  3 , L Rossi  4 , M C Leonardi  5 , P Ferrari  6 , M Marrocco  7 , E Gino  8 , S Cora  9 , G Loi  10 , F Rosica  11 , S Ren Kaiser  12 , E Verdolino  13 , L Strigari  14 , N Romeo  15 , L Placidi  16 , S Comi  17 , G De Otto  18 , A Roggio  19 , A Di Dio  3 , L Reversi  20 , E Pierpaoli  21 , E Infusino  22 , E Coeli  23 , T Licciardello  24 , A Ciarmatori  25 , R Caivano  26 , A Poggiu  27 , N Ciscognetti  28 , U Ricardi  29 , B Heijmen  4
Affiliations
Multicenter Study

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

C Fiandra et al. Phys Med. 2024 Jul.

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: Boost and elective nodes; Multi-center autoplanning validation; Whole breast radiotherapy.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: (1) All authors have participated in (a) conception and design, or analysis and interpretation of the data; (b) drafting the article or revising it critically for important intellectual content; and (c) approval of the final version. (2) This manuscript has not been submitted to, nor is under review at, another journal or other publishing venue. (3) Stefania Zara is employees of the company “Tecnologie Avanzate TA Srl” that distributes the software RayStation in Italy; this company supports the group in terms of collecting data. Data were analyzed objectively and independently from the vendor; (4) Remaining authors have no affiliation with any organization with a direct or indirect financial interest in the subject matter discussed in the manuscript.

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