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Dosimetry and efficiency comparison of knowledge-based and manual planning using volumetric modulated arc therapy for craniospinal irradiation

Wei-Ta Tsai
Wei-Ta Tsai
, 
Hui-Ling Hsieh
Hui-Ling Hsieh
, 
Shih-Kai Hung
Shih-Kai Hung
, 
Chi-Fu Zeng
Chi-Fu Zeng
, 
Ming-Fen Lee
Ming-Fen Lee
, 
Po-Hao Lin
Po-Hao Lin
, 
Chia-Yi Lin
Chia-Yi Lin
, 
Wei-Chih Li
Wei-Chih Li
, 
Wen-Yen Chiou
Wen-Yen Chiou
 oraz 
Tung-Hsin Wu
Tung-Hsin Wu
   | 07 mar 2024
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Article Category: Research Article
Data publikacji: 07 mar 2024
Zakres stron: 289 - 299
Otrzymano: 04 lis 2023
Przyjęty: 03 sty 2024
DOI: https://doi.org/10.2478/raon-2024-0018
Słowa kluczowe
© 2024 Wei-Ta Tsai et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

Flowchart of the study design.CSI = craniospinal irradiation; CT = computed tomography; KBP = knowledge-based planning; VMAT = volumetric modulated arc therapy
Flowchart of the study design.CSI = craniospinal irradiation; CT = computed tomography; KBP = knowledge-based planning; VMAT = volumetric modulated arc therapy

FIGURE 2.

Example of the target and field setup. (A) The arrangement of the brain field (dotted lines), spine-superior field (solid lines), spine-inferior field (dashed lines), and their isocenters. Each field overlaps at least 5 cm for the low-dose gradient junction. (B) Full arc was used on the brain field. (C) Partial arc was used in the spinal fields for arm sparing.
Example of the target and field setup. (A) The arrangement of the brain field (dotted lines), spine-superior field (solid lines), spine-inferior field (dashed lines), and their isocenters. Each field overlaps at least 5 cm for the low-dose gradient junction. (B) Full arc was used on the brain field. (C) Partial arc was used in the spinal fields for arm sparing.

FIGURE 3.

(A) Population-averaged dose-volume histogram (DVH) for all organs at risk and targets. (B) The population-averaged DVH for targets only.CTV = clinical target volume; MP = manual optimization plan; PTV = planning target volumes; RPI = RapidPlan initial; RPF = final RapidPlan after manual re-optimization
(A) Population-averaged dose-volume histogram (DVH) for all organs at risk and targets. (B) The population-averaged DVH for targets only.CTV = clinical target volume; MP = manual optimization plan; PTV = planning target volumes; RPI = RapidPlan initial; RPF = final RapidPlan after manual re-optimization

FIGURE 4.

Comparison of the planning time for MP, RPI, and RPF. The error bar represents one standard deviation.MP = manual optimization plan; RPI = RapidPlan initial; RPF = final RapidPlan after manual re-optimization
Comparison of the planning time for MP, RPI, and RPF. The error bar represents one standard deviation.MP = manual optimization plan; RPI = RapidPlan initial; RPF = final RapidPlan after manual re-optimization

Dosimetric goals and results for organs at risk

OAR parameters Goals Results P value
MP RPI RPF MP vs. RPF MP vs. RPF RPI vs. RPI
Brain
  Dmax [Gy] < 60 39.34 ± 0.39 40.24 ± 0.61 39.28 ± 0.37 < 0.01** 0.46 < 0.01**
Brain stem
  Dmax [Gy] < 54 38.48 ± 0.41 39.03 ± 0.46 38.51 ± 0.28 < 0.01** 0.91 < 0.01**
Chiasm
  Dmean [Gy] < 50 37.15 ± 0.35 37.10 ± 0.32 36.95 ± 0.32 0.69 0.07 0.06
  Dmax [Gy] < 55 38.13 ± 0.40 38.73 ± 0.55 38.20 ± 0.26 0.01* 0.46 < 0.01**
Optic nerves
  Dmean [Gy] < 50 27.61 ± 3.40 22.90 ± 2.39 22.42 ± 2.29 < 0.01** < 0.01** 0.05
  Dmax [Gy] < 55 37.13 ± 0.69 36.36 ± 1.72 36.15 ± 1.39 0.13 0.02* 0.13
Eyes
  Dmax [Gy] < 50 25.55 ± 3.57 22.52 ± 3.83 21.60 ± 3.86 0.02* 0.01* 0.01*
Lens
  Dmax [Gy] < 10 8.40 ± 0.68 8.87 ± 1.00 8.10 ± 0.55 0.11 0.21 < 0.01**
Parotid glands
  Dmean [Gy] < 25 7.38 ± 2.52 5.16 ± 0.39 4.95 ± 0.39 < 0.01** < 0.01** < 0.01**
Spinal cord
  Dmax [Gy] < 50 38.93 ± 0.51 39.81 ± 0.67 39.04 ± 0.56 < 0.01** < 0.01** < 0.01**
Thyroid
  Dmax [Gy] < 45 17.23 ± 4.04 16.68 ± 2.13 16.38 ± 2.04 0.59 0.36 0.07
Lungs
  Dmean [Gy] < 13 4.63 ± 0.30 4.95 ± 0.43 4.63 ± 0.24 0.03* 0.73 < 0.01**
  V20Gy [%] < 22 0.06 ± 0.11 0.04 ± 0.08 0.03 ± 0.04 0.64 0.44 0.33
  V5Gy [%] < 42 36.48 ± 2.88 42.77 ± 5.62 37.11 ± 2.87 0.01* 0.69 < 0.01**
Heart
  Dmean [Gy] < 10 6.76 ± 1.47 5.53 ± 0.82 5.70 ± 0.93 0.01* 0.02* 0.33
  V40Gy [%] < 3 0.00 ± 0.00 0.00 ± 0.00 0.00 ± 0.00 - - -
  V18Gy [%] < 5 0.04 ± 0.10 0.01 ± 0.03 0.01 ± 0.02 0.31 0.23 0.41
Esophagus
  Dmean [Gy] < 34 14.34 ± 1.62 13.23 ± 1.63 13.30 ± 1.74 0.01* < 0.01** 0.96
Liver
  Dmean [Gy] < 30 4.82 ± 0.94 4.57 ± 0.73 4.45 ± 0.70 0.61 0.33 < 0.01**
Kidneys
  Dmean [Gy] < 18 2.81 ± 1.17 2.47 ± 0.46 2.38 ± 0.43 0.96 0.73 < 0.01**

The mean dose of the OARs outside the targets contours

Organ Mean dose P value
MP RPI RPF MP vs. RPI MP vs. RPF RPI vs. RPF
Optic nerves 27.61 ± 3.40 22.90 ± 2.39 22.42 ± 2.29 < 0.01** < 0.01** 0.05
Eyes 12.11 ± 1.99 10.16 ± 0.55 9.83 ± 0.74 0.01* 0.01* 0.02*
Lens 7.09 ± 0.67 7.21 ± 0.52 6.78 ± 0.39 0.43 0.16 < 0.01**
Parotid glands 7.38 ± 2.52 5.16 ± 0.39 4.95 ± 0.39 < 0.01** < 0.01** < 0.01**
Thyroid 10.41 ± 3.37 9.00 ± 1.94 8.51 ± 2.07 0.06 0.04* < 0.01**
Lungs 4.63 ± 0.30 4.95 ± 0.43 4.63 ± 0.24 0.03* 0.73 < 0.01**
Heart 6.76 ± 1.47 5.53 ± 0.82 5.70 ± 0.93 0.01* 0.02* 0.33
Liver 4.82 ± 0.94 4.57 ± 0.73 4.45 ± 0.70 0.61 0.33 < 0.01**
Kidneys 2.81 ± 1.17 2.47 ± 0.46 2.38 ± 0.43 0.96 0.73 < 0.01**

Dosimetric comparison between manual plans, RapidPlan initial, and RapidPlan final

Parameters Goals Results P value
MP RPI RPF MP vs. RPI MP vs. RPF RPI vs. RPF
CTV
  V95 [%] > 99 99.99 ± 0.03 99.98 ± 0.03 99.97 ± 0.03 0.36 0.03* 0.09
  V100 [%] > 99 99.20 ± 0.17 98.37 ± 0.33 99.37 ± 0.23 < 0.01** 0.07 < 0.01**
  V107 [%] Minimize 0.62 ± 0.59 2.94 ± 4.33 0.46 ± 0.66 < 0.01** 0.16 < 0.01**
  Dmean [Gy] 36 37.23 ± 0.18 37.31 ± 0.21 37.22 ± 0.24 0.07 0.87 0.13
  Dmax [Gy] Minimize 39.38 ± 0.40 40.38 ± 0.57 39.42 ± 0.41 < 0.01** 0.78 < 0.01**
  D2 [%] < 107 106.12 ± 0.73 106.95 ± 0.96 105.72 ± 0.84 < 0.01** 0.19 < 0.01**
PTV
  V95 [%] > 98 99.68 ± 0.15 99.55 ± 0.23 99.24 ± 0.32 0.03* < 0.01** < 0.01**
  V100 [%] = 95 95.00 ± 0.00 95.00 ± 0.00 95.00 ± 0.00 - - -
  V107 [%] Minimize 0.62 ± 0.57 3.01 ± 4.12 0.44 ± 0.61 < 0.01** 0.17 < 0.01**
  Dmean [Gy] 36 37.10 ± 0.16 37.22 ± 0.18 37.08 ± 0.20 0.05 0.73 0.01*
  Dmax [%] < 112 109.99 ± 1.17 112.89 ± 1.78 110.17 ± 1.14 < 0.01** 0.57 < 0.01**
  D2 [%] < 107 106.09 ± 0.73 107.00 ± 0.93 105.71 ± 0.80 < 0.01** 0.21 < 0.01**
  CI 1 0.98 ± 0.01 1.01 ± 0.01 1.00 ± 0.01 < 0.01** < 0.01** 0.01*
  HI 1 1.10 ± 0.01 1.13 ± 0.02 1.10 ± 0.01 < 0.01** 0.57 < 0.01**
eISSN:
1581-3207
Język:
Angielski
Częstotliwość wydawania:
4 razy w roku
Dziedziny czasopisma:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
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