title: Fully automated simultaneous integrated boosted-intensity modulated radiation therapy treatment planning is feasible for head-and-neck cancer: a prospective clinical study.
abstract: OBJECTIVE
  To prospectively determine whether overlap volume histogram (OVH)-driven, automated simultaneous integrated boosted (SIB)-intensity-modulated radiation therapy (IMRT) treatment planning for head-and-neck cancer can be implemented in clinics.
  
  
  METHODS
  A prospective study was designed to compare fully automated plans (APs) created by an OVH-driven, automated planning application with clinical plans (CPs) created by dosimetrists in a 3-dose-level (70 Gy, 63 Gy, and 58.1 Gy), head-and-neck SIB-IMRT planning. Because primary organ sparing (cord, brain, brainstem, mandible, and optic nerve/chiasm) always received the highest priority in clinical planning, the study aimed to show the noninferiority of APs with respect to PTV coverage and secondary organ sparing (parotid, brachial plexus, esophagus, larynx, inner ear, and oral mucosa). The sample size was determined a priori by a superiority hypothesis test that had 85% power to detect a 4% dose decrease in secondary organ sparing with a 2-sided alpha level of 0.05. A generalized estimating equation (GEE) regression model was used for statistical comparison.
  
  
  RESULTS
  Forty consecutive patients were accrued from July to December 2010. GEE analysis indicated that in APs, overall average dose to the secondary organs was reduced by 1.16 (95% CI = 0.09-2.33) with P=.04, overall average PTV coverage was increased by 0.26% (95% CI = 0.06-0.47) with P=.02 and overall average dose to the primary organs was reduced by 1.14 Gy (95% CI = 0.45-1.8) with P=.004. A physician determined that all APs could be delivered to patients, and APs were clinically superior in 27 of 40 cases.
  
  
  CONCLUSIONS
  The application can be implemented in clinics as a fast, reliable, and consistent way of generating plans that need only minor adjustments to meet specific clinical needs.
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins University, Baltimore, Maryland, USA. binbin.wu@gunet.georgetown.edu
authors.forename: Binbin
authors.initials: B
authors.lastname: Wu
authors.forename: Todd
authors.initials: T
authors.lastname: McNutt
authors.forename: Marianna
authors.initials: M
authors.lastname: Zahurak
authors.forename: Patricio
authors.initials: P
authors.lastname: Simari
authors.forename: Dalong
authors.initials: D
authors.lastname: Pang
authors.forename: Russell
authors.initials: R
authors.lastname: Taylor
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sanguineti
mesh_terms: D005240:Feasibility Studies; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D058958:Organs at Risk / Q000528:radiation effects; D011446:Prospective Studies; D011832:Radiation Injuries / Q000517:prevention & control; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012044:Regression Analysis; D018401:Sample Size