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Koetsier KS, Oud M, de Klerck E, Hensen EF, van Vulpen M, van Linge A, Paul van Benthem P, Slagter C, Habraken SJ, Hoogeman MS, Méndez Romero A. Cochlear-optimized treatment planning in photon and proton radiosurgery for vestibular schwannoma patients. Clin Transl Radiat Oncol 2023; 43:100689. [PMID: 37867612 PMCID: PMC10585330 DOI: 10.1016/j.ctro.2023.100689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Objective To investigate the potential to reduce the cochlear dose with robotic photon radiosurgery or intensity-modulated proton therapy planning for vestibular schwannomas. Materials and Methods Clinically delivered photon radiosurgery treatment plans were compared to five cochlear-optimized plans: one photon and four proton plans (total of 120). A 1x12 Gy dose was prescribed. Photon plans were generated with Precision (Cyberknife, Accuray) with no PTV margin for set-up errors. Proton plans were generated using an in-house automated multi-criterial planning system with three or nine-beam arrangements, and applying 0 or 3 mm robustness for set-up errors during plan optimization and evaluation (and 3 % range robustness). The sample size was calculated based on a reduction of cochlear Dmean > 1.5 Gy(RBE) from the clinical plans, and resulted in 24 patients. Results Compared to the clinical photon plans, a reduction of cochlear Dmean > 1.5 Gy(RBE) could be achieved in 11/24 cochlear-optimized photon plans, 4/24 and 6/24 cochlear-optimized proton plans without set-up robustness for three and nine-beam arrangement, respectively, and in 0/24 proton plans with set-up robustness. The cochlea could best be spared in cases with a distance between tumor and cochlea. Using nine proton beams resulted in a reduced dose to most organs at risk. Conclusion Cochlear dose reduction is possible in vestibular schwannoma radiosurgery while maintaining tumor coverage, especially when the tumor is not adjacent to the cochlea. With current set-up robustness, proton therapy is capable of providing lower dose to organs at risk located distant to the tumor, but not for organs adjacent to it. Consequently, photon plans provided better cochlear sparing than proton plans.
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Affiliation(s)
- Kimberley S. Koetsier
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands
| | - Michelle Oud
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Erik de Klerck
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands
| | | | - Anne van Linge
- Department of Otorhinolaryngology and Head & Neck Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Peter Paul van Benthem
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands
| | - Cleo Slagter
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - Steven J.M. Habraken
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - Mischa S. Hoogeman
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - A. Méndez Romero
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
- HollandPTC, Delft, the Netherlands
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Rossi L, Méndez Romero A, Milder M, de Klerck E, Breedveld S, Heijmen B. Individualized automated planning for dose bath reduction in robotic radiosurgery for benign tumors. PLoS One 2019; 14:e0210279. [PMID: 30726214 PMCID: PMC6364873 DOI: 10.1371/journal.pone.0210279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/19/2018] [Indexed: 12/05/2022] Open
Abstract
Object To explore the use of automated planning in robotic radiosurgery of benign vestibular schwannoma (VS) tumors for dose reduction outside the planning target volume (PTV) to potentially reduce risk of secondary tumor induction. Methods A system for automated planning (AUTOplans) for VS patients was set up. The goal of AUTO- planning was to reduce the dose bath, including the occurrence of high dose spikes leaking from the PTV into normal tissues, without worsening PTV coverage, OAR doses, or treatment time. For 20 VS patients treated with 1x12 Gy, the AUTOplan was compared with the plan generated with conventional, manual trial-and-error planning (MANplan). Results With equal PTV coverage, AUTOplans showed clinically negligible differences with MANplans in OAR sparing (largest mean difference for all OARs: ΔD2% = 0.2 Gy). AUTOplan dose distributions were more compact: mean/maximum reductions of 23.6/53.8% and 9.6/28.5% in patient volumes receiving more than 1 or 6 Gy, respectively (p<0.001). AUTOplans also showed smaller dose spikes with mean/maximum reductions of 22.8/37.2% and 14.2/40.4% in D2% for shells at 1 and 7 cm distance from the PTV, respectively (p<0.001). Conclusion Automated planning for benign VS tumors highly outperformed manual planning with respect to the dose bath outside the PTV, without deteriorating PTV coverage or OAR sparing, or significantly increasing treatment time.
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Affiliation(s)
- Linda Rossi
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- * E-mail:
| | | | - Maaike Milder
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Erik de Klerck
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Sebastiaan Breedveld
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ben Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Moustakis C, Chan MKH, Kim J, Nilsson J, Bergman A, Bichay TJ, Palazon Cano I, Cilla S, Deodato F, Doro R, Dunst J, Eich HT, Fau P, Fong M, Haverkamp U, Heinze S, Hildebrandt G, Imhoff D, de Klerck E, Köhn J, Lambrecht U, Loutfi-Krauss B, Ebrahimi F, Masi L, Mayville AH, Mestrovic A, Milder M, Morganti AG, Rades D, Ramm U, Rödel C, Siebert FA, den Toom W, Wang L, Wurster S, Schweikard A, Soltys SG, Ryu S, Blanck O. Treatment planning for spinal radiosurgery : A competitive multiplatform benchmark challenge. Strahlenther Onkol 2018; 194:843-854. [PMID: 29802435 DOI: 10.1007/s00066-018-1314-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/08/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate the quality of treatment plans of spinal radiosurgery derived from different planning and delivery systems. The comparisons include robotic delivery and intensity modulated arc therapy (IMAT) approaches. Multiple centers with equal systems were used to reduce a bias based on individual's planning abilities. The study used a series of three complex spine lesions to maximize the difference in plan quality among the various approaches. METHODS Internationally recognized experts in the field of treatment planning and spinal radiosurgery from 12 centers with various treatment planning systems participated. For a complex spinal lesion, the results were compared against a previously published benchmark plan derived for CyberKnife radiosurgery (CKRS) using circular cones only. For two additional cases, one with multiple small lesions infiltrating three vertebrae and a single vertebra lesion treated with integrated boost, the results were compared against a benchmark plan generated using a best practice guideline for CKRS. All plans were rated based on a previously established ranking system. RESULTS All 12 centers could reach equality (n = 4) or outperform (n = 8) the benchmark plan. For the multiple lesions and the single vertebra lesion plan only 5 and 3 of the 12 centers, respectively, reached equality or outperformed the best practice benchmark plan. However, the absolute differences in target and critical structure dosimetry were small and strongly planner-dependent rather than system-dependent. Overall, gantry-based IMAT with simple planning techniques (two coplanar arcs) produced faster treatments and significantly outperformed static gantry intensity modulated radiation therapy (IMRT) and multileaf collimator (MLC) or non-MLC CKRS treatment plan quality regardless of the system (mean rank out of 4 was 1.2 vs. 3.1, p = 0.002). CONCLUSIONS High plan quality for complex spinal radiosurgery was achieved among all systems and all participating centers in this planning challenge. This study concludes that simple IMAT techniques can generate significantly better plan quality compared to previous established CKRS benchmarks.
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Affiliation(s)
- Christos Moustakis
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
| | - Mark K H Chan
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Jinkoo Kim
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Joakim Nilsson
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Alanah Bergman
- Vancouver Cancer Centre, Department of Medical Physics, BC Cancer Agency, Vancouver, BC, Canada
| | - Tewfik J Bichay
- Lacks Cancer Center, Department of Radiation Oncology, Mercy Health Saint Mary's, Grand Rapids, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Savino Cilla
- Fondazione di Ricerca e Cura "Giovanni Paolo II", Medical Physics Unit, Catholic University of Sacred Heart, Campobasso, Italy
| | - Francesco Deodato
- Fondazione di Ricerca e Cura "Giovanni Paolo II", Radiation Oncology Unit, Catholic University of Sacred Heart, Campobasso, Italy
| | - Raffaela Doro
- Department of Medical Physics and Radiation Oncology, IFCA, Firenze, Italy
| | - Jürgen Dunst
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Kiel, Germany.,Department of Radiation Oncology, University Clinic Copenhagen, Copenhagen, Denmark
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Pierre Fau
- University of Aix Marseille, Marseille, France.,Physics Department, Institut Paoli Calmettes, Marseille, France
| | - Ming Fong
- Vancouver Cancer Centre, Department of Radiation Therapy, BC Cancer Agency, Vancouver, BC, Canada
| | - Uwe Haverkamp
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Simon Heinze
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Guido Hildebrandt
- Department of Radiation Oncology, University Medicine Rostock, Rostock, Germany
| | - Detlef Imhoff
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Erik de Klerck
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Janett Köhn
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ulrike Lambrecht
- Department of Radiation Oncology, University Clinic Erlangen, Erlangen, Germany
| | - Britta Loutfi-Krauss
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Fatemeh Ebrahimi
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Laura Masi
- Department of Medical Physics and Radiation Oncology, IFCA, Firenze, Italy
| | - Alan H Mayville
- Lacks Cancer Center, Department of Radiation Oncology, Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Ante Mestrovic
- Vancouver Cancer Centre, Department of Medical Physics, BC Cancer Agency, Vancouver, BC, Canada
| | - Maaike Milder
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Alessio G Morganti
- Radiation Oncology Department, DIMES University of Bologna-S. Orsola Malpighi Hospital, Bologna, Italy
| | - Dirk Rades
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Lübeck, Germany
| | - Ulla Ramm
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Claus Rödel
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Frank-Andre Siebert
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Wilhelm den Toom
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Lei Wang
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Stefan Wurster
- Saphir Radiosurgery Center, Northern Germany and Frankfurt, Güstrow, Germany.,Department of Radiation Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Achim Schweikard
- Institute for Robotic and Cognitive Systems, University of Lübeck, Lübeck, Germany
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Oliver Blanck
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Kiel, Germany.,Saphir Radiosurgery Center, Northern Germany and Frankfurt, Güstrow, Germany
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