Comprehensive dosimetric and clinical evaluation of lexicographic optimization-based planning for cervical cancer
AimIn this study, a not yet commercially available fully-automated lexicographic optimization (LO) planning algorithm, called mCycle (Elekta AB, Stockholm, Sweden), was validated for cervical cancer.Material and methodsTwenty-four mono-institutional consecutive treatment plans (50 Gy/25 fx) delivere...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.1041839/full |
| _version_ | 1811312922247299072 |
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| author | Sara Trivellato Paolo Caricato Paolo Caricato Roberto Pellegrini Gianluca Montanari Martina Camilla Daniotti Martina Camilla Daniotti Bianca Bordigoni Bianca Bordigoni Valeria Faccenda Valeria Faccenda Denis Panizza Denis Panizza Sofia Meregalli Sofia Meregalli Elisa Bonetto Stefano Arcangeli Stefano Arcangeli Elena De Ponti Elena De Ponti |
| author_facet | Sara Trivellato Paolo Caricato Paolo Caricato Roberto Pellegrini Gianluca Montanari Martina Camilla Daniotti Martina Camilla Daniotti Bianca Bordigoni Bianca Bordigoni Valeria Faccenda Valeria Faccenda Denis Panizza Denis Panizza Sofia Meregalli Sofia Meregalli Elisa Bonetto Stefano Arcangeli Stefano Arcangeli Elena De Ponti Elena De Ponti |
| author_sort | Sara Trivellato |
| collection | DOAJ |
| description | AimIn this study, a not yet commercially available fully-automated lexicographic optimization (LO) planning algorithm, called mCycle (Elekta AB, Stockholm, Sweden), was validated for cervical cancer.Material and methodsTwenty-four mono-institutional consecutive treatment plans (50 Gy/25 fx) delivered between November 2019 and April 2022 were retrospectively selected. The automatic re-planning was performed by mCycle, implemented in the Monaco TPS research version (v5.59.13), in which the LO and Multicriterial Optimization (MCO) are coupled with Monte Carlo calculation. mCycle optimization follows an a priori assigned priority list, the so-called Wish List (WL), representing a dialogue between the radiation oncologist and the planner, setting hard constraints and following objectives. The WL was tuned on a patient subset according to the institution’s clinical protocol to obtain an optimal plan in a single optimization. This robust WL was then used to automatically re-plan the remaining patients. Manual plans (MP) and mCycle plans (mCP) were compared in terms of dose distributions, complexity (modulation complexity score, MCS), and delivery accuracy (perpendicular diode matrices, gamma analysis-passing ratio, PR). Their clinical acceptability was assessed through the blind choice of two radiation oncologists. Finally, a global quality score index (SI) was defined to gather into a single number the plan evaluation process.ResultsThe WL tuning requested four patients. The 20 automated re-planning tasks took three working days. The median optimization and calculation time can be estimated at 4 h and just over 1 h per MP and mCP, respectively. The dose comparison showed a comparable organ-at-risk spare. The planning target volume coverage increased (V95%: MP 98.0% [95.6–99.3]; mCP 99.2%[89.7–99.9], p >0.05). A significant increase has been registered in MCS (MP 0.29 [0.24–0.34]; mCP 0.26 [0.23–0.30], p <0.05) without affecting delivery accuracy (PR (3%/3mm): MP 97.0% [92.7–99.2]; mCP 97.1% [95.0–98.6], p >0.05). In the blind choice, all mCP results were clinically acceptable and chosen over MP in more than 75% of cases. The median SI score was 0.69 [0.41–0.84] and 0.73 [0.51–0.82] for MP and mCP, respectively (p >0.05).ConclusionsmCycle plans were comparable to clinical manual plans, more complex but accurately deliverable and registering a similar SI. Automated plans outperformed manual plans in blinded clinical choice. |
| first_indexed | 2024-04-13T10:45:08Z |
| format | Article |
| id | doaj.art-b1627e8bbe7542afb5e96e9bd202cf09 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-13T10:45:08Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-b1627e8bbe7542afb5e96e9bd202cf092022-12-22T02:49:49ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-11-011210.3389/fonc.2022.10418391041839Comprehensive dosimetric and clinical evaluation of lexicographic optimization-based planning for cervical cancerSara Trivellato0Paolo Caricato1Paolo Caricato2Roberto Pellegrini3Gianluca Montanari4Martina Camilla Daniotti5Martina Camilla Daniotti6Bianca Bordigoni7Bianca Bordigoni8Valeria Faccenda9Valeria Faccenda10Denis Panizza11Denis Panizza12Sofia Meregalli13Sofia Meregalli14Elisa Bonetto15Stefano Arcangeli16Stefano Arcangeli17Elena De Ponti18Elena De Ponti19Medical Physics Department, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, ItalyMedical Physics Department, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, ItalyDepartment of Physics, University of Milan, Milan, ItalyGlobal Clinical Science, Elekta AB, Stockholm, SwedenMedical Physics Department, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, ItalyMedical Physics Department, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, ItalyDepartment of Physics, University of Milan, Milan, ItalyMedical Physics Department, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, ItalyDepartment of Physics, University of Milan Bicocca, Milan, ItalyMedical Physics Department, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, ItalyDepartment of Physics, University of Milan, Milan, ItalyMedical Physics Department, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, ItalySchool of Medicine and Surgery, University of Milan Bicocca, Milan, ItalySchool of Medicine and Surgery, University of Milan Bicocca, Milan, ItalyDepartment of Radiation Oncology, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, ItalyDepartment of Radiation Oncology, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, ItalySchool of Medicine and Surgery, University of Milan Bicocca, Milan, ItalyDepartment of Radiation Oncology, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, ItalyMedical Physics Department, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, ItalySchool of Medicine and Surgery, University of Milan Bicocca, Milan, ItalyAimIn this study, a not yet commercially available fully-automated lexicographic optimization (LO) planning algorithm, called mCycle (Elekta AB, Stockholm, Sweden), was validated for cervical cancer.Material and methodsTwenty-four mono-institutional consecutive treatment plans (50 Gy/25 fx) delivered between November 2019 and April 2022 were retrospectively selected. The automatic re-planning was performed by mCycle, implemented in the Monaco TPS research version (v5.59.13), in which the LO and Multicriterial Optimization (MCO) are coupled with Monte Carlo calculation. mCycle optimization follows an a priori assigned priority list, the so-called Wish List (WL), representing a dialogue between the radiation oncologist and the planner, setting hard constraints and following objectives. The WL was tuned on a patient subset according to the institution’s clinical protocol to obtain an optimal plan in a single optimization. This robust WL was then used to automatically re-plan the remaining patients. Manual plans (MP) and mCycle plans (mCP) were compared in terms of dose distributions, complexity (modulation complexity score, MCS), and delivery accuracy (perpendicular diode matrices, gamma analysis-passing ratio, PR). Their clinical acceptability was assessed through the blind choice of two radiation oncologists. Finally, a global quality score index (SI) was defined to gather into a single number the plan evaluation process.ResultsThe WL tuning requested four patients. The 20 automated re-planning tasks took three working days. The median optimization and calculation time can be estimated at 4 h and just over 1 h per MP and mCP, respectively. The dose comparison showed a comparable organ-at-risk spare. The planning target volume coverage increased (V95%: MP 98.0% [95.6–99.3]; mCP 99.2%[89.7–99.9], p >0.05). A significant increase has been registered in MCS (MP 0.29 [0.24–0.34]; mCP 0.26 [0.23–0.30], p <0.05) without affecting delivery accuracy (PR (3%/3mm): MP 97.0% [92.7–99.2]; mCP 97.1% [95.0–98.6], p >0.05). In the blind choice, all mCP results were clinically acceptable and chosen over MP in more than 75% of cases. The median SI score was 0.69 [0.41–0.84] and 0.73 [0.51–0.82] for MP and mCP, respectively (p >0.05).ConclusionsmCycle plans were comparable to clinical manual plans, more complex but accurately deliverable and registering a similar SI. Automated plans outperformed manual plans in blinded clinical choice.https://www.frontiersin.org/articles/10.3389/fonc.2022.1041839/fulllexicographic optimizationautomated planningcervical cancerVMAT (volumetric modulated arc therapy)plan qualityplan comparison |
| spellingShingle | Sara Trivellato Paolo Caricato Paolo Caricato Roberto Pellegrini Gianluca Montanari Martina Camilla Daniotti Martina Camilla Daniotti Bianca Bordigoni Bianca Bordigoni Valeria Faccenda Valeria Faccenda Denis Panizza Denis Panizza Sofia Meregalli Sofia Meregalli Elisa Bonetto Stefano Arcangeli Stefano Arcangeli Elena De Ponti Elena De Ponti Comprehensive dosimetric and clinical evaluation of lexicographic optimization-based planning for cervical cancer Frontiers in Oncology lexicographic optimization automated planning cervical cancer VMAT (volumetric modulated arc therapy) plan quality plan comparison |
| title | Comprehensive dosimetric and clinical evaluation of lexicographic optimization-based planning for cervical cancer |
| title_full | Comprehensive dosimetric and clinical evaluation of lexicographic optimization-based planning for cervical cancer |
| title_fullStr | Comprehensive dosimetric and clinical evaluation of lexicographic optimization-based planning for cervical cancer |
| title_full_unstemmed | Comprehensive dosimetric and clinical evaluation of lexicographic optimization-based planning for cervical cancer |
| title_short | Comprehensive dosimetric and clinical evaluation of lexicographic optimization-based planning for cervical cancer |
| title_sort | comprehensive dosimetric and clinical evaluation of lexicographic optimization based planning for cervical cancer |
| topic | lexicographic optimization automated planning cervical cancer VMAT (volumetric modulated arc therapy) plan quality plan comparison |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.1041839/full |
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