Fully automated VMAT treatment planning for advanced-stage NSCLC patients.
OBJECTIVE
To develop a fully automated procedure for multicriterial volumetric modulated arc therapy (VMAT) treatment planning (autoVMAT) for stage III/IV non-small cell lung cancer (NSCLC) patients treated with curative intent.


METHODS
After configuring the developed autoVMAT system for NSCLC, autoVMAT plans were compared with manually generated clinically delivered intensity-modulated radiotherapy (IMRT) plans for 41 patients. AutoVMAT plans were also compared to manually generated VMAT plans in the absence of time pressure. For 16 patients with reduced planning target volume (PTV) dose prescription in the clinical IMRT plan (to avoid violation of organs at risk tolerances), the potential for dose escalation with autoVMAT was explored.


RESULTS
Two physicians evaluated 35/41 autoVMAT plans (85%) as clinically acceptable. Compared to the manually generated IMRT plans, autoVMAT plans showed statistically significant improved PTV coverage (V95%increased by 1.1% ± 1.1%), higher dose conformity (R50reduced by 12.2% ± 12.7%), and reduced mean lung, heart, and esophagus doses (reductions of 0.9 Gy ± 1.0 Gy, 1.5 Gy ± 1.8 Gy, 3.6 Gy ± 2.8 Gy, respectively, all p < 0.001). To render the six remaining autoVMAT plans clinically acceptable, a dosimetrist needed less than 10 min hands-on time for fine-tuning. AutoVMAT plans were also considered equivalent or better than manually optimized VMAT plans. For 6/16 patients, autoVMAT allowed tumor dose escalation of 5-10 Gy.


CONCLUSIONS
Clinically deliverable, high-quality autoVMAT plans can be generated fully automatically for the vast majority of advanced-stage NSCLC patients. For a subset of patients, autoVMAT allowed for tumor dose escalation.
Department of Radiation Oncology, Erasmus MC Cancer Institute, 5201, 3008 AE, Rotterdam, The Netherlands.|Scuola di Scienze, Alma Mater Studiorum, Università di Bologna, Bologna, Italy.
Giuseppe
G
Della Gala
Department of Radiation Oncology, Erasmus MC Cancer Institute, 5201, 3008 AE, Rotterdam, The Netherlands. m.dirkx@erasmusmc.nl.
Maarten L P
MLP
Dirkx
Department of Radiation Oncology, Erasmus MC Cancer Institute, 5201, 3008 AE, Rotterdam, The Netherlands.
Nienke
N
Hoekstra
Department of Radiation Oncology, Erasmus MC Cancer Institute, 5201, 3008 AE, Rotterdam, The Netherlands.
Dennie
D
Fransen
Scuola di Scienze, Alma Mater Studiorum, Università di Bologna, Bologna, Italy.
Nico
N
Lanconelli
Department of Radiation Oncology, Erasmus MC Cancer Institute, 5201, 3008 AE, Rotterdam, The Netherlands.
Marjan
M
van de Pol
Department of Radiation Oncology, Erasmus MC Cancer Institute, 5201, 3008 AE, Rotterdam, The Netherlands.
Ben J M
BJM
Heijmen
Department of Radiation Oncology, Erasmus MC Cancer Institute, 5201, 3008 AE, Rotterdam, The Netherlands.|Department of Radiation Oncology, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA.
Steven F
SF
Petit
D000465:Algorithms; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000532:radiotherapy*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D009367:Neoplasm Staging; D058958:Organs at Risk / Q000528:radiation effects; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012984:Software; D016896:Treatment Outcome; D047368:Tumor Burden / Q000528:radiation effects; D014584:User-Computer Interface
Computer-assisted radiotherapy planning; Non-small cell lung carcinoma; Organs at risk; Radiotherapy, intensity-modulated; Volumetric-modulated arc therapy