Improved VMAT planning for head and neck tumors with an advanced optimization algorithm

In this study, the “Progressive Resolution Optimizer PRO3“ (Varian Medical Systems) is compared to the previous version „PRO2“ with respect to its potential to improve dose sparing to the organs at risk (OAR) and dose coverage of the PTV for head and neck cancer patients. For eight head and neck can...

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Published in:	Zeitschrift für medizinische Physik Vol. 25; no. 4; pp. 333 - 340
Main Authors:	Klippel, Norbert, Schmücking, Michael, Terribilini, Dario, Geretschläger, Andreas, Aebersold, Daniel M., Manser, Peter
Format:	Journal Article
Language:	English
Published:	Germany Elsevier GmbH 01.12.2015
Subjects:	Absorption, Radiation Algorithms Head and Neck Neoplasms - radiotherapy Head and neck tumors Humans Kopf- und Hals-Tumore Organ Sparing Treatments - methods Organs at Risk - radiation effects Radiation oncology Radiation Protection - methods Radio-Onkologie Radiotherapy Dosage Radiotherapy Planning, Computer-Assisted - methods Radiotherapy, Intensity-Modulated - methods Reproducibility of Results Scattering, Radiation Sensitivity and Specificity Therapieplanung Therapy planning VMAT Head and neck tumors VMAT Radio-Onkologie Kopf- und Hals-Tumore Radiation oncology Therapy planning Therapieplanung
ISSN:	0939-3889, 1876-4436
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Abstract	In this study, the “Progressive Resolution Optimizer PRO3“ (Varian Medical Systems) is compared to the previous version „PRO2“ with respect to its potential to improve dose sparing to the organs at risk (OAR) and dose coverage of the PTV for head and neck cancer patients. For eight head and neck cancer patients, volumetric modulated arc therapy (VMAT) treatment plans were generated in this study. All cases have 2-3 phases and the total prescribed dose (PD) was 60-72Gy in the PTV. The study is mainly focused on the phase 1 plans, which all have an identical PD of 54Gy, and complex PTV structures with an overlap to the parotids. Optimization was performed based on planning objectives for the PTV according to ICRU83, and with minimal dose to spinal cord, and parotids outside PTV. In order to assess the quality of the optimization algorithms, an identical set of constraints was used for both, PRO2 and PRO3. The resulting treatment plans were investigated with respect to dose distribution based on the analysis of the dose volume histograms. For the phase 1 plans (PD=54Gy) the near maximum dose D2% of the spinal cord, could be minimized to 22±5 Gy with PRO3, as compared to 32±12Gy with PRO2, averaged for all patients. The mean dose to the parotids was also lower in PRO3 plans compared to PRO2, but the differences were less pronounced. A PTV coverage of V95%=97±1% could be reached with PRO3, as compared to 86±5% with PRO2. In clinical routine, these PRO2 plans would require modifications to obtain better PTV coverage at the cost of higher OAR doses. A comparison between PRO3 and PRO2 optimization algorithms was performed for eight head and neck cancer patients. In general, the quality of VMAT plans for head and neck patients are improved with PRO3 as compared to PRO2. The dose to OARs can be reduced significantly, especially for the spinal cord. These reductions are achieved with better PTV coverage as compared to PRO2. The improved spinal cord sparing offers new opportunities for all types of paraspinal tumors and for re-irradiation of recurrent tumors or second malignancies. In dieser Studie wird der „Progressive Resolution Optimizer PRO3“ (Varian Medical Systems) mit der Vorgängerversion „PRO2“ gezielt auf sein Potential bei Kopf-Hals-Tumoren untersucht. Im Vordergrund stehen die Dosisabdeckung des PTV und die Schonung der Risikoorgane (OAR). Für acht Patienten wurden VMAT-Pläne mit beiden Algorithmen erstellt. Die Gesamtdosis im PTV von 60-72Gy ist in allen Fällen auf 2-3 Phasen verteilt, die nacheinander abgestrahlt werden. Die Studie ist fokussiert auf die erste Bestrahlungsphase, die in allen Fällen eine komplexe PTV-Struktur mit Planungsdosis von 54Gy hatte und teilweise mit den Parotiden überlappte. Grundlage für die Optimierung sind die ICRU83-Richtlinien für das PTV und das Planungsziel, das Rückenmark und die Parotiden außerhalb des PTV maximal zu schonen. In einem ersten Schritt wurde durch interaktive Planung mit PRO3 ein möglichst optimaler Plan generiert. Die dabei gewählten Grenzwerte („dose constraints“) für PTV und Risikoorgane wurden in einem zweiten Schritt für den Vergleich der Optimierungsalgorithmen verwendet. Die Optimierung wurde also für diese nun fest vorgegebenen Dosisgrenzwerte sowohl mit PRO3 wiederholt als auch mit PRO2 durchgeführt, ohne zusätzliche Interaktion des Planers. Die resultierenden beiden Bestrahlungspläne wurden anhand der Dosis-Volumen-Histogramme verglichen. Ein markanter Unterschied in Planqualität ergibt sich aus dem Vergleich der Rückenmarkdosis in der ersten Bestrahlungsphase mit 54Gy Dosis im PTV. Die maximum-nahe Dosis D2% im Rückenmark konnte mit PRO3 auf 22±5Gy reduziert werden, während die Optimierung mit identischen Randbedingungen bei PRO2 eine Dosis D2% von 32±12 Gy ergab. Auch die mittlere Dosis für die Parotiden war kleiner mit PRO3, allerdings mit einem weniger großen Unterschied. Eine PTV-Abdeckung von V95%=97±1% konnte mit PRO3 erreicht werden. Mit PRO2 lag diese Abdeckung dagegen nur bei V95%=86±5%. Die Mehrzahl der so generierten PRO2-Pläne würde in klinischer Routine nicht akzeptiert und müsste durch die Anpassung der Randbedingungen modifiziert werden, so dass die Dosis auf die Risikoorgane entsprechend höher wird. Ein Vergleich der Optimierungsalgorithmen PRO2 und PRO3 wurde bei acht Patienten mit Kopf-Hals-Tumoren durchgeführt. Hierbei wurde mit dem Algorithmus PRO3 eine deutlich bessere Planqualität erzielt als mit PRO2. Die Verbesserung führt zu einer tieferen Belastung der Risikoorgane, mit dem deutlichsten Unterschied beim Rückenmark. Diese Schonung geht nicht zu Lasten der PTV-Abdeckung. Vielmehr wurde bei allen PRO3-Plänen eine bessere PTV-Abdeckung erzielt als mit PRO2. Die verbesserte Möglichkeit der Rückenmarkschonung, auch für komplexe PTV, eröffnet neue Möglichkeiten der Bestrahlung paraspinaler Tumore. Durch die Schonung des Rückenmarks ist zudem eine erneute Bestrahlung bei wiederauftretenden Tumoren möglich.
AbstractList	In this study, the “Progressive Resolution Optimizer PRO3“ (Varian Medical Systems) is compared to the previous version „PRO2“ with respect to its potential to improve dose sparing to the organs at risk (OAR) and dose coverage of the PTV for head and neck cancer patients. For eight head and neck cancer patients, volumetric modulated arc therapy (VMAT) treatment plans were generated in this study. All cases have 2-3 phases and the total prescribed dose (PD) was 60-72Gy in the PTV. The study is mainly focused on the phase 1 plans, which all have an identical PD of 54Gy, and complex PTV structures with an overlap to the parotids. Optimization was performed based on planning objectives for the PTV according to ICRU83, and with minimal dose to spinal cord, and parotids outside PTV. In order to assess the quality of the optimization algorithms, an identical set of constraints was used for both, PRO2 and PRO3. The resulting treatment plans were investigated with respect to dose distribution based on the analysis of the dose volume histograms. For the phase 1 plans (PD=54Gy) the near maximum dose D2% of the spinal cord, could be minimized to 22±5 Gy with PRO3, as compared to 32±12Gy with PRO2, averaged for all patients. The mean dose to the parotids was also lower in PRO3 plans compared to PRO2, but the differences were less pronounced. A PTV coverage of V95%=97±1% could be reached with PRO3, as compared to 86±5% with PRO2. In clinical routine, these PRO2 plans would require modifications to obtain better PTV coverage at the cost of higher OAR doses. A comparison between PRO3 and PRO2 optimization algorithms was performed for eight head and neck cancer patients. In general, the quality of VMAT plans for head and neck patients are improved with PRO3 as compared to PRO2. The dose to OARs can be reduced significantly, especially for the spinal cord. These reductions are achieved with better PTV coverage as compared to PRO2. The improved spinal cord sparing offers new opportunities for all types of paraspinal tumors and for re-irradiation of recurrent tumors or second malignancies. In dieser Studie wird der „Progressive Resolution Optimizer PRO3“ (Varian Medical Systems) mit der Vorgängerversion „PRO2“ gezielt auf sein Potential bei Kopf-Hals-Tumoren untersucht. Im Vordergrund stehen die Dosisabdeckung des PTV und die Schonung der Risikoorgane (OAR). Für acht Patienten wurden VMAT-Pläne mit beiden Algorithmen erstellt. Die Gesamtdosis im PTV von 60-72Gy ist in allen Fällen auf 2-3 Phasen verteilt, die nacheinander abgestrahlt werden. Die Studie ist fokussiert auf die erste Bestrahlungsphase, die in allen Fällen eine komplexe PTV-Struktur mit Planungsdosis von 54Gy hatte und teilweise mit den Parotiden überlappte. Grundlage für die Optimierung sind die ICRU83-Richtlinien für das PTV und das Planungsziel, das Rückenmark und die Parotiden außerhalb des PTV maximal zu schonen. In einem ersten Schritt wurde durch interaktive Planung mit PRO3 ein möglichst optimaler Plan generiert. Die dabei gewählten Grenzwerte („dose constraints“) für PTV und Risikoorgane wurden in einem zweiten Schritt für den Vergleich der Optimierungsalgorithmen verwendet. Die Optimierung wurde also für diese nun fest vorgegebenen Dosisgrenzwerte sowohl mit PRO3 wiederholt als auch mit PRO2 durchgeführt, ohne zusätzliche Interaktion des Planers. Die resultierenden beiden Bestrahlungspläne wurden anhand der Dosis-Volumen-Histogramme verglichen. Ein markanter Unterschied in Planqualität ergibt sich aus dem Vergleich der Rückenmarkdosis in der ersten Bestrahlungsphase mit 54Gy Dosis im PTV. Die maximum-nahe Dosis D2% im Rückenmark konnte mit PRO3 auf 22±5Gy reduziert werden, während die Optimierung mit identischen Randbedingungen bei PRO2 eine Dosis D2% von 32±12 Gy ergab. Auch die mittlere Dosis für die Parotiden war kleiner mit PRO3, allerdings mit einem weniger großen Unterschied. Eine PTV-Abdeckung von V95%=97±1% konnte mit PRO3 erreicht werden. Mit PRO2 lag diese Abdeckung dagegen nur bei V95%=86±5%. Die Mehrzahl der so generierten PRO2-Pläne würde in klinischer Routine nicht akzeptiert und müsste durch die Anpassung der Randbedingungen modifiziert werden, so dass die Dosis auf die Risikoorgane entsprechend höher wird. Ein Vergleich der Optimierungsalgorithmen PRO2 und PRO3 wurde bei acht Patienten mit Kopf-Hals-Tumoren durchgeführt. Hierbei wurde mit dem Algorithmus PRO3 eine deutlich bessere Planqualität erzielt als mit PRO2. Die Verbesserung führt zu einer tieferen Belastung der Risikoorgane, mit dem deutlichsten Unterschied beim Rückenmark. Diese Schonung geht nicht zu Lasten der PTV-Abdeckung. Vielmehr wurde bei allen PRO3-Plänen eine bessere PTV-Abdeckung erzielt als mit PRO2. Die verbesserte Möglichkeit der Rückenmarkschonung, auch für komplexe PTV, eröffnet neue Möglichkeiten der Bestrahlung paraspinaler Tumore. Durch die Schonung des Rückenmarks ist zudem eine erneute Bestrahlung bei wiederauftretenden Tumoren möglich. In this study, the "Progressive Resolution Optimizer PRO3" (Varian Medical Systems) is compared to the previous version "PRO2" with respect to its potential to improve dose sparing to the organs at risk (OAR) and dose coverage of the PTV for head and neck cancer patients. For eight head and neck cancer patients, volumetric modulated arc therapy (VMAT) treatment plans were generated in this study. All cases have 2-3 phases and the total prescribed dose (PD) was 60-72 Gy in the PTV. The study is mainly focused on the phase 1 plans, which all have an identical PD of 54 Gy, and complex PTV structures with an overlap to the parotids. Optimization was performed based on planning objectives for the PTV according to ICRU83, and with minimal dose to spinal cord, and parotids outside PTV. In order to assess the quality of the optimization algorithms, an identical set of constraints was used for both, PRO2 and PRO3. The resulting treatment plans were investigated with respect to dose distribution based on the analysis of the dose volume histograms. For the phase 1 plans (PD = 54 Gy) the near maximum dose D2% of the spinal cord, could be minimized to 22 ± 5 Gy with PRO3, as compared to 32 ± 12 Gy with PRO2, averaged for all patients. The mean dose to the parotids was also lower in PRO3 plans compared to PRO2, but the differences were less pronounced. A PTV coverage of V95% = 97 ± 1% could be reached with PRO3, as compared to 86 ± 5% with PRO2. In clinical routine, these PRO2 plans would require modifications to obtain better PTV coverage at the cost of higher OAR doses. A comparison between PRO3 and PRO2 optimization algorithms was performed for eight head and neck cancer patients. In general, the quality of VMAT plans for head and neck patients are improved with PRO3 as compared to PRO2. The dose to OARs can be reduced significantly, especially for the spinal cord. These reductions are achieved with better PTV coverage as compared to PRO2. The improved spinal cord sparing offers new opportunities for all types of paraspinal tumors and for re-irradiation of recurrent tumors or second malignancies. OBJECTIVEIn this study, the "Progressive Resolution Optimizer PRO3" (Varian Medical Systems) is compared to the previous version "PRO2" with respect to its potential to improve dose sparing to the organs at risk (OAR) and dose coverage of the PTV for head and neck cancer patients.MATERIALS AND METHODSFor eight head and neck cancer patients, volumetric modulated arc therapy (VMAT) treatment plans were generated in this study. All cases have 2-3 phases and the total prescribed dose (PD) was 60-72 Gy in the PTV. The study is mainly focused on the phase 1 plans, which all have an identical PD of 54 Gy, and complex PTV structures with an overlap to the parotids. Optimization was performed based on planning objectives for the PTV according to ICRU83, and with minimal dose to spinal cord, and parotids outside PTV. In order to assess the quality of the optimization algorithms, an identical set of constraints was used for both, PRO2 and PRO3. The resulting treatment plans were investigated with respect to dose distribution based on the analysis of the dose volume histograms.RESULTSFor the phase 1 plans (PD = 54 Gy) the near maximum dose D2% of the spinal cord, could be minimized to 22 ± 5 Gy with PRO3, as compared to 32 ± 12 Gy with PRO2, averaged for all patients. The mean dose to the parotids was also lower in PRO3 plans compared to PRO2, but the differences were less pronounced. A PTV coverage of V95% = 97 ± 1% could be reached with PRO3, as compared to 86 ± 5% with PRO2. In clinical routine, these PRO2 plans would require modifications to obtain better PTV coverage at the cost of higher OAR doses.CONCLUSIONA comparison between PRO3 and PRO2 optimization algorithms was performed for eight head and neck cancer patients. In general, the quality of VMAT plans for head and neck patients are improved with PRO3 as compared to PRO2. The dose to OARs can be reduced significantly, especially for the spinal cord. These reductions are achieved with better PTV coverage as compared to PRO2. The improved spinal cord sparing offers new opportunities for all types of paraspinal tumors and for re-irradiation of recurrent tumors or second malignancies.
Author	Klippel, Norbert Aebersold, Daniel M. Terribilini, Dario Schmücking, Michael Geretschläger, Andreas Manser, Peter
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Keywords	Head and neck tumors VMAT Radio-Onkologie Kopf- und Hals-Tumore Radiation oncology Therapy planning Therapieplanung
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Snippet	In this study, the “Progressive Resolution Optimizer PRO3“ (Varian Medical Systems) is compared to the previous version „PRO2“ with respect to its potential to... In this study, the "Progressive Resolution Optimizer PRO3" (Varian Medical Systems) is compared to the previous version "PRO2" with respect to its potential to... OBJECTIVEIn this study, the "Progressive Resolution Optimizer PRO3" (Varian Medical Systems) is compared to the previous version "PRO2" with respect to its...
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SubjectTerms	Absorption, Radiation Algorithms Head and Neck Neoplasms - radiotherapy Head and neck tumors Humans Kopf- und Hals-Tumore Organ Sparing Treatments - methods Organs at Risk - radiation effects Radiation oncology Radiation Protection - methods Radio-Onkologie Radiotherapy Dosage Radiotherapy Planning, Computer-Assisted - methods Radiotherapy, Intensity-Modulated - methods Reproducibility of Results Scattering, Radiation Sensitivity and Specificity Therapieplanung Therapy planning VMAT
Title	Improved VMAT planning for head and neck tumors with an advanced optimization algorithm
URI	https://dx.doi.org/10.1016/j.zemedi.2015.05.002 https://www.ncbi.nlm.nih.gov/pubmed/26071076 https://www.proquest.com/docview/1749619211
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