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MO‐G‐201‐01: A Multi‐Institutional Study Investigating the Performance of a Knowledge‐Based Planning System Against Pinnacle Auto‐Planning Engine in SIB‐IMRT for the Head‐And‐Neck Cancer
Author(s) -
Wu B,
Kusters M,
Kunzebusch M,
Dijkema T,
McNutt T,
Sanguineti G,
Pang D
Publication year - 2016
Publication title -
medical physics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.473
H-Index - 180
eISSN - 2473-4209
pISSN - 0094-2405
DOI - 10.1118/1.4957367
Subject(s) - pinnacle , wilcoxon signed rank test , medical physics , computer science , nuclear medicine , radiation treatment planning , head and neck cancer , cancer , medicine , radiation therapy , radiology , mann–whitney u test
Purpose: Knowledge‐based Planning (KBP) founded on prior planning experience and Auto‐Planning Engine (APE; commercialized in Pinnacle v9.10 TPS) based on progressive optimization algorithm both aim to eliminate the trial‐and‐error process in radiotherapy inverse planning. This study investigates the performance of the approaches in a multi‐institutional setting to evaluate their functionalities in oropharyngeal cancer and offers suggestions how they can be implemented in the clinic. Methods: Radboud University Medical Center (RUMC) provided 35 oropharyngeal cancer patients (SIB‐IMRT with two‐dose‐level prescription: 68 Gy to PTV68 and 50.3 Gy to PTV50.3) with corresponding comparative APE plans. Johns Hopkins University (JHU) contributed to a three‐dose‐level (70 Gy 63 Gy and 58.1 Gy) plan library for RUMC's patient KBP generation. MedStar Georgetown University Hospital (MGUH) contributed to a KBP approach employing overlap‐volume histogram (OVH‐KBP) for generating RUMC's patient KBP plans using JHU's plan library. Since both approaches need their own user‐defined parameters as initial inputs the first 10 patients were set aside as training set to finalize them. Meanwhile cross‐institutional comparisons and adjustments were implemented for investigating institutions’ protocol discrepancies and the approaches’ user‐defined parameters were updated accordingly. The finalized parameters were then applied to the remaining 25 patients for OVH‐KBP and APE generation. A Wilcoxon rank‐sum test was used for statistical comparison with significance level of p<0.05. Results: On average PTV68's V95 was 96.5% in APE plans vs. 97% in OVH‐KBP plans (p=0.36); PTV50.3's V95 in APE plans was 97.8% vs.97.6% in OVH‐KBP plans (p=0.6); cord's D0.1 cc was 38.6 Gy in OVH‐KBP plans vs. 43.7 Gy in APE plans (p=0.0001); mean doses to larynxes oral cavities parotids and submandibular glands were similar with p>0.2. Conclusions: The study demonstrates that KBP and APE can generate plans of comparable quality in a multi‐institutional setting. Variations in clinical protocols can be effectively addressed for cross‐institutional adaptations. Binbin Wu and Todd McNutt are the co‐inventors of a patent associated with the proposed knowledge‐based planning system which was licensed to Varian Medical Systems in 2015; This research was in part supported by Philips Radiation Oncology Systems.