title: Performance of a Knowledge-Based Model for Optimization of Volumetric Modulated Arc Therapy Plans for Single and Bilateral Breast Irradiation.
abstract: OBJECTIVE
  To evaluate the performance of a model-based optimisation process for volumetric modulated arc therapy, VMAT, applied to whole breast irradiation.
  
  
  METHODS
  A set of 150 VMAT dose plans with simultaneous integrated boost were selected to train a model for the prediction of dose-volume constraints. The dosimetric validation was done on different groups of patients from three institutes for single (50 cases) and bilateral breast (20 cases).
  
  
  RESULTS
  Quantitative improvements were observed between the model-based and the reference plans, particularly for heart dose. Of 460 analysed dose-volume objectives, 13% of the clinical plans failed to meet the constraints while the respective model-based plans succeeded. Only in 5 cases did the reference plans pass while the respective model-based failed the criteria. For the bilateral breast analysis, the model-based plans resulted in superior or equivalent dose distributions to the reference plans in 96% of the cases.
  
  
  CONCLUSIONS
  Plans optimised using a knowledge-based model to determine the dose-volume constraints showed dosimetric improvements when compared to earlier approved clinical plans. The model was applicable to patients from different centres for both single and bilateral breast irradiation. The data suggests that the dose-volume constraint optimisation can be effectively automated with the new engine and could encourage its application to clinical practice.
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, Milan-Rozzano, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Fogliata
authors.affiliation: Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Nicolini
authors.affiliation: Radiotherapy Department, ICM-Val d'Aurelle, Montpellier, France.
authors.forename: Celine
authors.initials: C
authors.lastname: Bourgier
authors.affiliation: Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Clivio
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, Milan-Rozzano, Italy.
authors.forename: Fiorenza
authors.initials: F
authors.lastname: De Rose
authors.affiliation: Radiotherapy Department, ICM-Val d'Aurelle, Montpellier, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Fenoglietto
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, Milan-Rozzano, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Lobefalo
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, Milan-Rozzano, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Mancosu
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, Milan-Rozzano, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tomatis
authors.affiliation: Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Vanetti
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, Milan-Rozzano, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, Milan-Rozzano, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
mesh_terms: D001940:Breast; D005260:Female; D006801:Humans; D051188:Knowledge Bases; D008954:Models, Biological; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*