Valeria Trojani, Melanie Grehn, Andrea Botti, Brian Balgobind, Alessandro Savini, Judit Boda-Heggemann, Marcin Miszczyk, Olgun Elicin, David Krug, Nicolaus Andratschke, Daniel Schmidhalter, Wouter van Elmpt, Marta Bogowicz, Javier de Areba Iglesias, Lukasz Dolla, Stefanie Ehrbar, Enric Fernandez-Velilla, Jens Fleckenstein, Domingo Granero, Dominik Henzen, Coen Hurkmans, Anne Kluge, Lukas Knybel, Sandy Loopeker, Alfredo Mirandola, Veronica Richetto, Gianluisa Sicignano, Veronique Vallet, Bram van Asselen, Esben Worm, Etienne Pruvot, Joost Verhoeff, Martin Fast, Mauro Iori, Oliver Blanck
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The STOPSTORM.eu consortium was established to investigate and harmonize STAR in Europe. The primary goal of this benchmark study was to investigate current treatment planning practice within the STOPSTORM project as a baseline for future harmonization.</p><p><strong>Methods and materials: </strong>Planning target volumes (PTVs) overlapping extracardiac organs-at-risk and/or cardiac substructures were generated for 3 STAR cases. Participating centers were asked to create single-fraction treatment plans with 25 Gy dose prescriptions based on in-house clinical practice. All treatment plans were reviewed by an expert panel and quantitative crowd knowledge-based analysis was performed with independent software using descriptive statistics for International Commission on Radiation Units and Measurements report 91 relevant parameters and crowd dose-volume histograms. Thereafter, treatment planning consensus statements were established using a dual-stage voting process.</p><p><strong>Results: </strong>Twenty centers submitted 67 treatment plans for this study. In most plans (75%) intensity modulated arc therapy with 6 MV flattening filter free beams was used. Dose prescription was mainly based on PTV D<sub>95%</sub> (49%) or D<sub>96%-100%</sub> (19%). Many participants preferred to spare close extracardiac organs-at-risk (75%) and cardiac substructures (50%) by PTV coverage reduction. PTV D<sub>0.035cm3</sub> ranged from 25.5 to 34.6 Gy, demonstrating a large variety of dose inhomogeneity. Estimated treatment times without motion compensation or setup ranged from 2 to 80 minutes. For the consensus statements, a strong agreement was reached for beam technique planning, dose calculation, prescription methods, and trade-offs between target and extracardiac critical structures. No agreement was reached on cardiac substructure dose limitations and on desired dose inhomogeneity in the target.</p><p><strong>Conclusions: </strong>This STOPSTORM multicenter treatment planning benchmark study not only showed strong agreement on several aspects of STAR treatment planning, but also revealed disagreement on others. 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引用次数: 0
摘要
背景和目的:立体定向心律失常射频消融术(STAR)在难治性室性心动过速(VT)患者中取得了良好的疗效。然而,临床数据稀缺且不尽相同。STOPSTORM.eu 联合会的成立旨在调查和协调欧洲的 STAR 研究。这项基准研究的主要目的是调查 STOPSTORM 项目中目前的治疗规划实践,作为未来统一的基线:方法:为三个 STAR 病例生成与心外高危器官和/或心脏下结构重叠的规划靶体积 (PTV)。要求参与中心根据内部临床实践制定25 Gy剂量处方的单部分治疗计划。专家小组对所有治疗计划进行了审查,并使用独立软件对 ICRU 报告 91 中的相关参数和人群剂量-体积-柱状图进行了基于人群知识的定量分析。随后,通过双阶段投票程序确定了治疗计划共识声明:20 个中心为本研究提交了 67 份治疗计划。在大多数计划中(75%),都使用了6 MV扁平无滤波器射束的调强弧治疗(IMAT)。剂量处方主要基于 PTV D95% (49%) 或 D96-100% (19%)。许多参与者倾向于通过缩小 PTV 覆盖范围来保留近距离的心外高危器官(75%)和心脏下结构(50%)。PTV D0.035cm3 的范围为 25.5-34.6 Gy,显示了剂量不均匀性的巨大差异。在没有运动补偿或设置的情况下,估计治疗时间为 2-80 分钟。就共识声明而言,在射束技术规划、剂量计算、处方方法以及目标和心脏外关键结构之间的权衡方面达成了高度一致。在心脏底层结构剂量限制和靶区所需的剂量不均匀性方面没有达成一致:这项 STOPSTORM 多中心治疗计划基准研究表明,在 STAR 治疗计划的几个方面存在很强的一致性,但也显示出在其他方面存在分歧。为了在未来实现 STAR 的标准化和统一化,研究人员制定了共识声明,但临床数据仍是制定可行治疗计划指南的迫切需要。
Refining Treatment Planning in STereotactic Arrhythmia Radioablation: Benchmark Results and Consensus Statement From the STOPSTORM.eu Consortium.
Purpose: STereotactic Arrhythmia Radioablation (STAR) showed promising results in patients with refractory ventricular tachycardia. However, clinical data are scarce and heterogeneous. The STOPSTORM.eu consortium was established to investigate and harmonize STAR in Europe. The primary goal of this benchmark study was to investigate current treatment planning practice within the STOPSTORM project as a baseline for future harmonization.
Methods and materials: Planning target volumes (PTVs) overlapping extracardiac organs-at-risk and/or cardiac substructures were generated for 3 STAR cases. Participating centers were asked to create single-fraction treatment plans with 25 Gy dose prescriptions based on in-house clinical practice. All treatment plans were reviewed by an expert panel and quantitative crowd knowledge-based analysis was performed with independent software using descriptive statistics for International Commission on Radiation Units and Measurements report 91 relevant parameters and crowd dose-volume histograms. Thereafter, treatment planning consensus statements were established using a dual-stage voting process.
Results: Twenty centers submitted 67 treatment plans for this study. In most plans (75%) intensity modulated arc therapy with 6 MV flattening filter free beams was used. Dose prescription was mainly based on PTV D95% (49%) or D96%-100% (19%). Many participants preferred to spare close extracardiac organs-at-risk (75%) and cardiac substructures (50%) by PTV coverage reduction. PTV D0.035cm3 ranged from 25.5 to 34.6 Gy, demonstrating a large variety of dose inhomogeneity. Estimated treatment times without motion compensation or setup ranged from 2 to 80 minutes. For the consensus statements, a strong agreement was reached for beam technique planning, dose calculation, prescription methods, and trade-offs between target and extracardiac critical structures. No agreement was reached on cardiac substructure dose limitations and on desired dose inhomogeneity in the target.
Conclusions: This STOPSTORM multicenter treatment planning benchmark study not only showed strong agreement on several aspects of STAR treatment planning, but also revealed disagreement on others. To standardize and harmonize STAR in the future, consensus statements were established; however, clinical data are urgently needed for actionable guidelines for treatment planning.
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.