Advantages and limitations of navigation-based multicriteria optimization (MCO) in selectively sparing pharyngeal constrictor muscles in head and neck radiotherapy treatment planning.

IF 2 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Applied Clinical Medical Physics Pub Date : 2025-06-05 DOI:10.1002/acm2.70112

Laura K Howard, Simon J P Meara, Ehab M Ibrahim, Carl G Rowbottom

{"title":"Advantages and limitations of navigation-based multicriteria optimization (MCO) in selectively sparing pharyngeal constrictor muscles in head and neck radiotherapy treatment planning.","authors":"Laura K Howard, Simon J P Meara, Ehab M Ibrahim, Carl G Rowbottom","doi":"10.1002/acm2.70112","DOIUrl":null,"url":null,"abstract":"Purpose: Sparing pharyngeal constrictor muscles (PCMs) during radiotherapy improves patient-reported swallowing function. This study aimed to explore the feasibility of integrating knowledge-based planning (KBP) with multicriteria optimization (MCO) in Eclipse v18.0 to selectively spare PCM, quantify the required trade-off in prophylactic planning target volume (PTV54) coverage, and to evaluate MCO performance.Method: Ten patients previously planned with KBP for oropharyngeal cancer (65, 60, and 54 Gy in 30 fractions) were retrospectively re-planned. Clinical plans were further optimized using trade-off exploration in MCO, with a priority order: spinal cord and brainstem sparing, high-dose and intermediate-dose target coverage, PCM sparing, low-dose target coverage, parotids sparing, remaining organs at risk (OAR). Plans were evaluated based on planning target volumes dose metrics (D50%, D98%, and D2%), homogeneity index (HI), conformity index (CI), and maximum and mean doses to OARs, and paired t-tests were performed. Differences between navigated and deliverable plans were analyzed. One patient underwent 10 identical repeat plan generations.Results: MCO reduced the average mean dose to the superior and middle PCM, inferior PCM, contralateral parotid, and larynx by 2.0, 3.4, 2.6, and 3.9 Gy, respectively (p < 0.05) but at the expense of HI and CI. No difference was observed in average PTV54 D98% between techniques; however, all clinical plans and seven MCO plans achieved D98% ≥ 95%, with three MCO plans modestly compromised (D98% 93.7%-94.6%). Dose metrics between navigated and deliverable plans differed by ≤0.7 Gy for mean doses and ≤1.8 Gy for maximum doses. Pareto surface generation was not repeatable.Conclusion: MCO effectively balances the trade-off between PCM sparing and low-dose target coverage. It may be a valuable tool in the context of personalized care.","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":" ","pages":"e70112"},"PeriodicalIF":2.0000,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Applied Clinical Medical Physics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/acm2.70112","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: Sparing pharyngeal constrictor muscles (PCMs) during radiotherapy improves patient-reported swallowing function. This study aimed to explore the feasibility of integrating knowledge-based planning (KBP) with multicriteria optimization (MCO) in Eclipse v18.0 to selectively spare PCM, quantify the required trade-off in prophylactic planning target volume (PTV54) coverage, and to evaluate MCO performance.

Method: Ten patients previously planned with KBP for oropharyngeal cancer (65, 60, and 54 Gy in 30 fractions) were retrospectively re-planned. Clinical plans were further optimized using trade-off exploration in MCO, with a priority order: spinal cord and brainstem sparing, high-dose and intermediate-dose target coverage, PCM sparing, low-dose target coverage, parotids sparing, remaining organs at risk (OAR). Plans were evaluated based on planning target volumes dose metrics (D_50%, D_98%, and D_2%), homogeneity index (HI), conformity index (CI), and maximum and mean doses to OARs, and paired t-tests were performed. Differences between navigated and deliverable plans were analyzed. One patient underwent 10 identical repeat plan generations.

Results: MCO reduced the average mean dose to the superior and middle PCM, inferior PCM, contralateral parotid, and larynx by 2.0, 3.4, 2.6, and 3.9 Gy, respectively (p < 0.05) but at the expense of HI and CI. No difference was observed in average PTV54 D_98% between techniques; however, all clinical plans and seven MCO plans achieved D_98% ≥ 95%, with three MCO plans modestly compromised (D_98% 93.7%-94.6%). Dose metrics between navigated and deliverable plans differed by ≤0.7 Gy for mean doses and ≤1.8 Gy for maximum doses. Pareto surface generation was not repeatable.

Conclusion: MCO effectively balances the trade-off between PCM sparing and low-dose target coverage. It may be a valuable tool in the context of personalized care.

查看原文本刊更多论文

基于导航的多标准优化（MCO）在头颈部放疗计划中选择性保留咽收缩肌的优势与局限性。

目的：在放疗期间保留咽收缩肌（PCMs）可改善患者报告的吞咽功能。本研究旨在探讨在Eclipse v18.0中集成基于知识的规划（KBP）与多准则优化（MCO）的可行性，以选择性地节省PCM，量化预防性规划目标体积（PTV54）覆盖率所需的权衡，并评估MCO的性能。方法：对10例原计划行口咽癌KBP治疗的患者（65、60、54 Gy，共30组）进行回顾性分析。通过MCO的权衡探索进一步优化临床计划，优先顺序为：脊髓和脑干保留、高剂量和中剂量靶覆盖、PCM保留、低剂量靶覆盖、腮腺保留、剩余危险器官（OAR）。根据计划目标体积剂量指标（D50%、D98%和D2%）、均匀性指数（HI）、符合性指数（CI）以及OARs的最大和平均剂量对计划进行评估，并进行配对t检验。分析了导航计划和可交付计划之间的差异。一名患者接受了10代相同的重复计划。结果：MCO使上、中PCM、下PCM、对侧腮腺和喉部的平均剂量分别降低2.0、3.4、2.6和3.9 Gy（技术间p为98%）；然而，所有临床计划和7个MCO计划均达到D98%≥95%，其中3个MCO计划中度受损（D98% 93.7%-94.6%）。导航计划和可交付计划之间的剂量指标在平均剂量≤0.7 Gy和最大剂量≤1.8 Gy之间存在差异。帕累托曲面生成不可重复。结论：MCO有效地平衡了PCM节约和低剂量靶覆盖率之间的权衡。在个性化护理中，它可能是一个有价值的工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Applied Clinical Medical Physics 医学-核医学

CiteScore

3.60

自引率

19.00%

发文量

331

审稿时长

3 months

期刊介绍： Journal of Applied Clinical Medical Physics is an international Open Access publication dedicated to clinical medical physics. JACMP welcomes original contributions dealing with all aspects of medical physics from scientists working in the clinical medical physics around the world. JACMP accepts only online submission. JACMP will publish: -Original Contributions: Peer-reviewed, investigations that represent new and significant contributions to the field. Recommended word count: up to 7500. -Review Articles: Reviews of major areas or sub-areas in the field of clinical medical physics. These articles may be of any length and are peer reviewed. -Technical Notes: These should be no longer than 3000 words, including key references. -Letters to the Editor: Comments on papers published in JACMP or on any other matters of interest to clinical medical physics. These should not be more than 1250 (including the literature) and their publication is only based on the decision of the editor, who occasionally asks experts on the merit of the contents. -Book Reviews: The editorial office solicits Book Reviews. -Announcements of Forthcoming Meetings: The Editor may provide notice of forthcoming meetings, course offerings, and other events relevant to clinical medical physics. -Parallel Opposed Editorial: We welcome topics relevant to clinical practice and medical physics profession. The contents can be controversial debate or opposed aspects of an issue. One author argues for the position and the other against. Each side of the debate contains an opening statement up to 800 words, followed by a rebuttal up to 500 words. Readers interested in participating in this series should contact the moderator with a proposed title and a short description of the topic