Savino Cilla1, Francesco Deodato2, Carmela Romano3, Anna Ianiro3, Gabriella Macchia2, Alessia Re2, Milly Buwenge4, Luca Boldrini5, Luca Indovina6, Vincenzo Valentini5, Alessio G Morganti4. 1. Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy. Electronic address: savino.cilla@gemellimolise.it. 2. Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy. 3. Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy. 4. Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; DIMES, Alma Mater Studiorum Bologna University, Italy. 5. Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli - Università Cattolica del Sacro Cuore, Roma, Italy. 6. Medical Physics Unit, Fondazione Policlinico Universitario A. Gemelli - Università Cattolica del Sacro Cuore, Roma, Italy.
Abstract
PURPOSE: To perform a comprehensive dosimetric and clinical evaluation of the new Pinnacle Personalized automated planning system for complex head-and-neck treatments. METHODS: Fifteen consecutive head-neck patients were enrolled. Radiotherapy was prescribed using VMAT with simultaneous integrated boost strategy. Personalized planning integrates the Feasibility engine able to supply an "a priori" DVH prediction of the achievability of planning goals. Comparison between clinically accepted manually-generated (MP) and automated (AP) plans was performed using dose-volume histograms and a blinded clinical evaluation by two radiation oncologists. Planning time between MP and AP was compared. Dose accuracy was validated using the PTW Octavius-4D phantom together with the 1500 2D-array. RESULTS: For similar targets coverage, AP plans reported less irradiation of healthy tissue, with significant dose reduction for spinal cord, brainstem and parotids. On average, the mean dose to parotids and maximal doses to spinal cord and brainstem were reduced by 13-15% (p < 0.001), 9% (p < 0.001) and 16% (p < 0.001), respectively. The integral dose was reduced by 16% (p < 0.001). The dose conformity for the three PTVs was significantly higher with AP plans (p < 0.001). The two oncologists chose AP plans in more than 80% of cases. Overall planning times were reduced to <30 min for automated optimization. All AP plans passed the 3%/2 mm γ-analysis by more than 95%. CONCLUSION: Complex head-neck plans created using Personalized automated engine provided an overall increase of plan quality, in terms of dose conformity and sparing of normal tissues. The Feasibility module allowed OARs dose sparing well beyond the clinical objectives.
PURPOSE: To perform a comprehensive dosimetric and clinical evaluation of the new Pinnacle Personalized automated planning system for complex head-and-neck treatments. METHODS: Fifteen consecutive head-neckpatients were enrolled. Radiotherapy was prescribed using VMAT with simultaneous integrated boost strategy. Personalized planning integrates the Feasibility engine able to supply an "a priori" DVH prediction of the achievability of planning goals. Comparison between clinically accepted manually-generated (MP) and automated (AP) plans was performed using dose-volume histograms and a blinded clinical evaluation by two radiation oncologists. Planning time between MP and AP was compared. Dose accuracy was validated using the PTW Octavius-4D phantom together with the 1500 2D-array. RESULTS: For similar targets coverage, AP plans reported less irradiation of healthy tissue, with significant dose reduction for spinal cord, brainstem and parotids. On average, the mean dose to parotids and maximal doses to spinal cord and brainstem were reduced by 13-15% (p < 0.001), 9% (p < 0.001) and 16% (p < 0.001), respectively. The integral dose was reduced by 16% (p < 0.001). The dose conformity for the three PTVs was significantly higher with AP plans (p < 0.001). The two oncologists chose AP plans in more than 80% of cases. Overall planning times were reduced to <30 min for automated optimization. All AP plans passed the 3%/2 mm γ-analysis by more than 95%. CONCLUSION: Complex head-neck plans created using Personalized automated engine provided an overall increase of plan quality, in terms of dose conformity and sparing of normal tissues. The Feasibility module allowed OARs dose sparing well beyond the clinical objectives.