Sophia C Kamran1, Birgit S Mueller2, Peter Paetzold3, Joseph Dunlap3, Andrzej Niemierko4, Thomas Bortfeld3, Henning Willers5, David Craft3. 1. Harvard Radiation Oncology Program, Boston, USA. 2. Department of Radiation Oncology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany; Physik-Department, Technische Universität München, Munich, Germany. 3. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA. 4. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Division of Biostatistics and Biomathematics, Massachusetts General Hospital, Harvard Medical School, Boston, USA. 5. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA. Electronic address: hwillers@mgh.harvard.edu.
Abstract
PURPOSE: In this planning study, we studied the benefit of intensity-modulated radiation therapy (IMRT) with multi-criteria optimization (MCO) in locally advanced non-small cell lung carcinoma (NSCLC). METHODS: We selected 10 consecutive patients with gross tumor within 1cm of the esophagus eligible for RTOG 1308, randomized phase II trial of 70Gy protons vs photons. Planning was performed per protocol. In addition, a novel approach for esophagus sparing was applied by making the contralateral esophagus (CE) an avoidance structure. MCO and non-MCO plans underwent double-blinded review. Plan differences in dose-volume histogram parameters were analyzed. RESULTS: Median plan differences were mean lung dose=0.8 Gy (p=0.01), lung V20=1.1% (p=0.06), heart V30=1.0% (p=0.03), heart V45=0.6% (p=0.03), esophagus V60=1.2% (p=0.04), and CE V45=3.2% (p=0.01), all favoring MCO over non-MCO. PTV coverage with 95% dose was ⩾98.0% for both plans. There were 5 minor protocol deviations with non-MCO plans and 2 with MCO. Median improvement of active planning time with MCO was 88 min (p<0.01). Physicians preferred 8 MCO and 2 non-MCO plans (p=0.04). CONCLUSIONS:MCO plans yielded significant improvements in organ-at-risk sparing without compromising target coverage, consumed less dosimetrist time, and were preferred by physicians. We suggest incorporating MCO into prospective clinical trials.
RCT Entities:
PURPOSE: In this planning study, we studied the benefit of intensity-modulated radiation therapy (IMRT) with multi-criteria optimization (MCO) in locally advanced non-small cell lung carcinoma (NSCLC). METHODS: We selected 10 consecutive patients with gross tumor within 1cm of the esophagus eligible for RTOG 1308, randomized phase II trial of 70 Gy protons vs photons. Planning was performed per protocol. In addition, a novel approach for esophagus sparing was applied by making the contralateral esophagus (CE) an avoidance structure. MCO and non-MCO plans underwent double-blinded review. Plan differences in dose-volume histogram parameters were analyzed. RESULTS: Median plan differences were mean lung dose=0.8 Gy (p=0.01), lung V20=1.1% (p=0.06), heart V30=1.0% (p=0.03), heart V45=0.6% (p=0.03), esophagus V60=1.2% (p=0.04), and CE V45=3.2% (p=0.01), all favoring MCO over non-MCO. PTV coverage with 95% dose was ⩾98.0% for both plans. There were 5 minor protocol deviations with non-MCO plans and 2 with MCO. Median improvement of active planning time with MCO was 88 min (p<0.01). Physicians preferred 8 MCO and 2 non-MCO plans (p=0.04). CONCLUSIONS: MCO plans yielded significant improvements in organ-at-risk sparing without compromising target coverage, consumed less dosimetrist time, and were preferred by physicians. We suggest incorporating MCO into prospective clinical trials.
Authors: Giuseppe Della Gala; Maarten L P Dirkx; Nienke Hoekstra; Dennie Fransen; Nico Lanconelli; Marjan van de Pol; Ben J M Heijmen; Steven F Petit Journal: Strahlenther Onkol Date: 2017-03-17 Impact factor: 3.621
Authors: Karen Chin Snyder; Justine Cunningham; Yimei Huang; Bo Zhao; Jennifer Dolan; Ning Wen; Indrin J Chetty; Mira M Shah; Salim M Siddiqui Journal: Adv Radiat Oncol Date: 2021-02-06