Planning Benchmark Study for Stereotactic Body Radiation Therapy of Pancreas Carcinomas With Simultaneously Integrated Boost and Protection: Results of the DEGRO/DGMP Working Group on Stereotactic Radiation Therapy and Radiosurgery.
Christos Moustakis, Oliver Blanck, Maximilian Grohmann, Dirk Albers, Dennis Bartels, Bastian Bathen, Giuseppina Rita Borzì, Sara Broggi, Andrea Bruschi, Michelina Casale, Anna Delana, Paul Doolan, Fatemeh Ebrahimi Tazehmahalleh, Stefania Fabiani, Maria Daniela Falco, Roman Fehr, Melissa Friedlein, Susanne Gutser, Abdul Malek Hamada, Timothy Hancock, Janett Köhn, Christine Kornhuber, Thomas Krieger, Ulrike Lambrecht, Sara Lappi, Eugenia Moretti, Annalena Mirus, Thomas Muedder, Sandija Plaude, Bernd Polvika, Valentina Ravaglia, Roberto Righetto, Giuseppe Rinaldin, Henrik Schachner, Alessandro Scaggion, Philipp Schilling, Philipp Szeverinski, Elena Villaggi, Mathias Walke, Lotte Wilke, Peter Winkler, Nils H Nicolay, Hans Theodor Eich, Eleni Gkika, Thomas B Brunner, Daniela Schmitt
{"title":"Planning Benchmark Study for Stereotactic Body Radiation Therapy of Pancreas Carcinomas With Simultaneously Integrated Boost and Protection: Results of the DEGRO/DGMP Working Group on Stereotactic Radiation Therapy and Radiosurgery.","authors":"Christos Moustakis, Oliver Blanck, Maximilian Grohmann, Dirk Albers, Dennis Bartels, Bastian Bathen, Giuseppina Rita Borzì, Sara Broggi, Andrea Bruschi, Michelina Casale, Anna Delana, Paul Doolan, Fatemeh Ebrahimi Tazehmahalleh, Stefania Fabiani, Maria Daniela Falco, Roman Fehr, Melissa Friedlein, Susanne Gutser, Abdul Malek Hamada, Timothy Hancock, Janett Köhn, Christine Kornhuber, Thomas Krieger, Ulrike Lambrecht, Sara Lappi, Eugenia Moretti, Annalena Mirus, Thomas Muedder, Sandija Plaude, Bernd Polvika, Valentina Ravaglia, Roberto Righetto, Giuseppe Rinaldin, Henrik Schachner, Alessandro Scaggion, Philipp Schilling, Philipp Szeverinski, Elena Villaggi, Mathias Walke, Lotte Wilke, Peter Winkler, Nils H Nicolay, Hans Theodor Eich, Eleni Gkika, Thomas B Brunner, Daniela Schmitt","doi":"10.1016/j.ijrobp.2024.08.038","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The proximity or overlap of planning target volume (PTV) and organs-at-risk (OARs) poses a major challenge in stereotactic body radiation therapy (SBRT) of pancreatic cancer (PACA). This international treatment planning benchmark study investigates whether simultaneous integrated boost (SIB) and simultaneous integrated protection (SIP) concepts in PACA SBRT can lead to improved and harmonized plan quality.</p><p><strong>Methods and materials: </strong>A multiparametric specification of desired target doses (gross target volume [GTV]<sub>D50%</sub>, GTV<sub>D99%</sub>, PTV<sub>D95%</sub>, and PTV<sub>0.5cc</sub>) with 2 prescription doses of GTV<sub>D50%</sub> = 5 × 9.2Gy (46 Gy) and GTV<sub>D50%</sub> = 8 × 8.25 Gy (66 Gy) and OAR limits were distributed with planning computed tomography and contours from 3 PACA patients. In phase 1, plans were ranked using a scoring system for comparison of trade-offs between GTV/PTV and OAR. In phase 2, replanning was performed for the most challenging case and prescription with dedicated SIB and SIP contours provided for optimization after group discussion.</p><p><strong>Results: </strong>For all 3 cases and both phases combined, 292 plans were generated from 42 institutions in 5 countries using commonly available treatment planning systems. The GTV<sub>D50%</sub> prescription was performed by only 76% and 74% of planners within 2% for 5 and 8 fractions, respectively. The GTV<sub>D99%</sub> goal was mostly reached, while the balance between OAR and target dose showed initial SIB/SIP-like optimization strategies in about 50% of plans. For plan ranking, 149 and 217 score penalties were given for 5 and 8 fractions, pointing to improvement possibilities. For phase 2, the GTV<sub>D50%</sub> prescription was performed by 95% of planners within 2%, and GTV<sub>D99%</sub> as well as OAR doses were better harmonized with notable less score penalties. Fourteen of 19 planners improved their plan rank, 9 of them by at least 2 ranks.</p><p><strong>Conclusions: </strong>Dedicated SIB/SIP concepts in combination with multiparametric prescriptions and constraints can lead to overall harmonized and high treatment plan quality for PACA SBRT. Standardized SIB/SIP treatment planning in multicenter clinical trials appears feasible after group consensus and training.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"547-557"},"PeriodicalIF":6.4000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Radiation Oncology Biology Physics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ijrobp.2024.08.038","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/1 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: The proximity or overlap of planning target volume (PTV) and organs-at-risk (OARs) poses a major challenge in stereotactic body radiation therapy (SBRT) of pancreatic cancer (PACA). This international treatment planning benchmark study investigates whether simultaneous integrated boost (SIB) and simultaneous integrated protection (SIP) concepts in PACA SBRT can lead to improved and harmonized plan quality.
Methods and materials: A multiparametric specification of desired target doses (gross target volume [GTV]D50%, GTVD99%, PTVD95%, and PTV0.5cc) with 2 prescription doses of GTVD50% = 5 × 9.2Gy (46 Gy) and GTVD50% = 8 × 8.25 Gy (66 Gy) and OAR limits were distributed with planning computed tomography and contours from 3 PACA patients. In phase 1, plans were ranked using a scoring system for comparison of trade-offs between GTV/PTV and OAR. In phase 2, replanning was performed for the most challenging case and prescription with dedicated SIB and SIP contours provided for optimization after group discussion.
Results: For all 3 cases and both phases combined, 292 plans were generated from 42 institutions in 5 countries using commonly available treatment planning systems. The GTVD50% prescription was performed by only 76% and 74% of planners within 2% for 5 and 8 fractions, respectively. The GTVD99% goal was mostly reached, while the balance between OAR and target dose showed initial SIB/SIP-like optimization strategies in about 50% of plans. For plan ranking, 149 and 217 score penalties were given for 5 and 8 fractions, pointing to improvement possibilities. For phase 2, the GTVD50% prescription was performed by 95% of planners within 2%, and GTVD99% as well as OAR doses were better harmonized with notable less score penalties. Fourteen of 19 planners improved their plan rank, 9 of them by at least 2 ranks.
Conclusions: Dedicated SIB/SIP concepts in combination with multiparametric prescriptions and constraints can lead to overall harmonized and high treatment plan quality for PACA SBRT. Standardized SIB/SIP treatment planning in multicenter clinical trials appears feasible after group consensus and training.
期刊介绍：
International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field.
This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.
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