Abstract
This is the first study that compared treatment plan quality and planning efficiency
for lung stereotactic body radiation therapy (SBRT) using CyberKnife (CK) Multiplan
vs Varian Eclipse treatment planning systems, including volumetric modulated arc therapy
(VMAT) and knowledge-based VMAT (KBP-VMAT). Thirteen lung SBRT patients treated with
50 to 55 Gy in 3 or 5 fractions were retrospectively included in this study. CK plans
created with Multiplan V. 4.6.1 using 2 fixed circular cones were previously approved
used for treatment. For the comparison, the computed tomography (CT) data sets and
contours from the CK plans were used to generate VMAT and KBP-VMAT plans (University
of California San Diego publicly-shared RapidPlan model) using Eclipse V. 13.7. Metrics
used for the comparison of CK, VMAT, and KBP-VMAT plans included monitor units (MUs),
conformity indices, dose heterogeneity, high-dose spillage, low-dose spillage, adjacent
organs at risk (OAR) doses, and treatment planning time. One-way analysis of variance
with post-hoc Tukey tests and paired t-tests were used to analyze the difference of
these metrics corresponding to the different planning techniques. All of the 3 planning
techniques achieved our clinical goals. With similar planning target volume (PTV)
coverage, CK plans yielded the most MU (p< 0.001), the least dose homogeneity (p < 0.002), and the least D2cm dose (p < 0.001), while KBP-VMAT plans resulted in the most OAR sparing. No significant difference
was found among other dosimetric metrics such as high-dose spillage, lung V20 and
volume receiving 50% of the prescription dose. Compared to VMAT, KBP-VMAT improved
OAR sparing (p < 0.05), but required significantly more MU (p < 0.001). KBP-VMAT was associated with the shortest planning time. Eclipse-based
VMAT can achieve comparable plan quality for lung SBRT as CK, in a more efficient
manner. RapidPlan can facilitate the planning process of KBP-VMAT, with potentially
better OAR sparing but higher MU requirements. Further improvement for KBP-VMAT is
likely achievable by developing site-specific patient models.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Medical DosimetryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Reference
Key Statistics for Lung Cancer. https://www.cancer.org/cancer/non-small-cell-lung-cancer/about/key-statistics.html. Accessed September 16, 2019.
- Analysis of stage and clinical/prognostic factors for lung cancer from SEER registries: AJCC staging and collaborative stage data collection system.Cancer. 2014; 120: 3781-3792https://doi.org/10.1002/cncr.29045
- Non–small cell lung cancer, Version 5.2017, NCCN clinical practice guidelines in oncology.J Natl Comprehens Cancer Netw. 2017; 15: 504-535https://doi.org/10.6004/jnccn.2017.0050
- Complications from stereotactic body radiotherapy for lung cancer.Cancers (Basel). 2015; 7: 981-1004https://doi.org/10.3390/cancers7020820
Stereotactic body radiation therapy: The report of AAPM Task Group 101. - PubMed - NCBI. https://www.ncbi.nlm.nih.gov/pubmed/20879569. Accessed September 20, 2019.
- Clinical outcomes of cyberknife stereotactic radiosurgery for lung metastases.J Thorac Dis. 2015; 7: 407-412https://doi.org/10.3978/j.issn.2072-1439.2015.01.09
- Cyberknife ® stereotactic radiation therapy for stage I lung cancer and pulmonary metastases: evaluation of local control at 24 months.J Thorac Disease. 2018; 10 (4976-4984-4984)
- Volumetric modulated arc therapy: A review of current literature and clinical use in practice.Br J Radiol. 2011; 84: 967-996https://doi.org/10.1259/bjr/22373346
- Rapid delivery of stereotactic radiotherapy for peripheral lung tumors using volumetric intensity-modulated arcs.Radiother Oncol. 2009; 93: 122-124https://doi.org/10.1016/j.radonc.2009.05.020
- A dosimetric evaluation of VMAT for the treatment of non‐small cell lung cancer.J Appl Clin Med Phys. 2012; 14: 228-238https://doi.org/10.1120/jacmp.v14i1.4110
- Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique.Oncol Lett. 2018; 15: 3928-3936https://doi.org/10.3892/ol.2018.7809
- Automation in intensity modulated radiotherapy treatment planning—A review of recent innovations.Br J Radiol. 2018; 9120180270https://doi.org/10.1259/bjr.20180270
- Knowledge-light adaptation approaches in case-based reasoning for radiotherapy treatment planning.Artif Intell Med. 2016; 68: 17-28https://doi.org/10.1016/j.artmed.2016.01.006
- Contextual Atlas Regression Forests: multiple-atlas-based automated dose prediction in radiation therapy.IEEE Trans Med Imaging. 2016; 35: 1000-1012https://doi.org/10.1109/TMI.2015.2505188
- Atlas-guided prostate intensity modulated radiation therapy (IMRT) planning.Phys Med Biol. 2015; 60: 7277-7291https://doi.org/10.1088/0031-9155/60/18/7277
- Quality assessment for VMAT prostate radiotherapy planning based on data envelopment analysis.Phys Med Biol. 2013; 58: 5753-5769https://doi.org/10.1088/0031-9155/58/16/5753
- Vector-model-supported approach in prostate plan optimization.Med Dosim. 2017; 42: 79-84https://doi.org/10.1016/j.meddos.2017.01.001
- Knowledge-based IMRT treatment planning for prostate cancer.Med Phys. 2011; 38: 2515-2522https://doi.org/10.1118/1.3574874
- Geometric dose prediction model for hemithoracic intensity-modulated radiation therapy in mesothelioma patients with two intact lungs.J Appl Clin Med Phys. 2016; 17: 371-379https://doi.org/10.1120/jacmp.v17i3.6199
- Method of predicting the mean lung dose based on a patient׳s anatomy and dose-volume histograms.Med Dosim. 2017; 42: 57-62https://doi.org/10.1016/j.meddos.2016.12.001
- Accurate prediction of target dose-escalation and organ-at-risk dose levels for non-small cell lung cancer patients.Radiother Oncol. 2015; 117: 453-458https://doi.org/10.1016/j.radonc.2015.07.040
- Assessment of a knowledge-based RapidPlan model for patients with postoperative cervical cancer.Precis Radiat Oncol. 2017; 1: 102-107https://doi.org/10.1002/pro6.23
- RapidPlan head and neck model: The objectives and possible clinical benefit.Radiat Oncol. 2017; 12: 73https://doi.org/10.1186/s13014-017-0808-x
- An analysis of knowledge-based planning for stereotactic body radiation therapy of the spine.Pract Radiat Oncol. 2017; 7: e355-e360https://doi.org/10.1016/j.prro.2017.02.007
- Development and evaluation of a clinical model for lung cancer patients using stereotactic body radiotherapy (SBRT) within a knowledge‐based algorithm for treatment planning.J Appl Clin Med Phys. 2016; 17: 263-275https://doi.org/10.1120/jacmp.v17i6.6429
- A dosimetric comparison of stereotactic body radiation therapy techniques for lung cancer: robotic versus conventional LINAC-based systems.J Appl Clin Med Phys. 2010; 11: 3223https://doi.org/10.1120/jacmp.v11i3.3223
- Dosimetric evaluation of four-dimensional dose distributions of CyberKnife and volumetric-modulated arc radiotherapy in stereotactic body lung radiotherapy.J Appl Clin Med Phys. 2013; 14: 4229https://doi.org/10.1120/jacmp.v14i4.4229
- Applying a RapidPlan model trained on a technique and orientation to another: A feasibility and dosimetric evaluation.Radiat Oncol. 2016; 11https://doi.org/10.1186/s13014-016-0684-9
- Multi-institutional validation of a knowledge-based planning model for patients enrolled in RTOG 0617: Implications for plan quality controls in Cooperative Group Trials.Pract Radiat Oncol. 2019; 9: e218-e227https://doi.org/10.1016/j.prro.2018.11.007
- Evaluation of multiple institutions’ models for knowledge-based planning of volumetric modulated arc therapy (VMAT) for prostate cancer.Radiat Oncol. 2018; 13https://doi.org/10.1186/s13014-018-0994-1
UCSD RapidPlan models—UCSD Knowledge-based radiotherapy initiative. http://ucsd.knowledgebasedrt.org/ucsdmodels. Accessed September 20, 2019.
- Standardization of terminology in stereotactic radiosurgery: Report from the Standardization Committee of the International Leksell Gamma Knife Society: special topic.J Neurosurg. 2014; 121https://doi.org/10.3171/2014.7.GKS141199
Article info
Publication history
Published online: June 10, 2020
Accepted:
April 17,
2020
Received in revised form:
January 15,
2020
Received:
November 1,
2019
Identification
Copyright
© 2020 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
