Clinical Acceptability of Fully Automated External Beam Radiotherapy for Cervical Cancer With Three Different Beam Delivery Techniques

Authors

Dong Joo Rhee
Anuja Jhingran
Kai Huang
Tucker J Netherton
Nazia Fakie
Ingrid White
Alicia Sherriff
Carlos E Cardenas
Lifei Zhang
Surendra Prajapati
Stephen F Kry
Beth M Beadle
William Shaw
Frederika O'Reilly
Jeannette Parkes
Hester Burger
Chris Trauernicht
Hannah Simonds
Laurence E Court

Publication Date

9-1-2022

Journal

Medical Physics

Abstract

Purpose: To fully automate CT-based cervical cancer radiotherapy by automating contouring and planning for three different treatment techniques.

Methods: We automated three different radiotherapy planning techniques for locally advanced cervical cancer: 2D 4-field-box (4-field-box), 3D conformal radiotherapy (3D-CRT), and volumetric modulated arc therapy (VMAT). These auto-planning algorithms were combined with a previously developed auto-contouring system. To improve the quality of the 4-field-box and 3D-CRT plans, we used an in-house, field-in-field (FIF) automation program. Thirty-five plans were generated for each technique on CT scans from multiple institutions and evaluated by five experienced radiation oncologists from three different countries. Every plan was reviewed by two of the five radiation oncologists and scored using a 5-point Likert scale.

Results: Overall, 87%, 99%, and 94% of the automatically generated plans were found to be clinically acceptable without modification for the 4-field-box, 3D-CRT, and VMAT plans, respectively. Some customizations of the FIF configuration were necessary on the basis of radiation oncologist preference. Additionally, in some cases, it was necessary to renormalize the plan after it was generated to satisfy radiation oncologist preference.

Conclusion: Approximately, 90% of the automatically generated plans were clinically acceptable for all three planning techniques. This fully automated planning system has been implemented into the radiation planning assistant for further testing in resource-constrained radiotherapy departments in low- and middle-income countries.

Keywords

Female, Humans, Organs at Risk, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted, Radiotherapy, Conformal, Radiotherapy, Intensity-Modulated, Uterine Cervical Neoplasms, auto‐contouring, auto‐planning, cervical cancer, field‐in‐field

DOI

10.1002/mp.15868

PMID

35866442

PMCID

PMC9474595

PubMedCentral® Posted Date

7-26-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes