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Evaluation of automatic VMAT plans in locally advanced nasopharyngeal carcinoma

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Abstract

Objective

This study aimed to evaluate the quality of locally advanced nasopharyngeal carcinoma (NPC) radiotherapy plans generated by the automated planning module of a commercial treatment planning system (TPS).

Methods

Data of 30 patients with locally advanced NPC were retrospectively investigated. For each patient, volumetric modulated arc therapy (VMAT) plans with double arcs were generated manually by experienced physicists and automatically in the Pinnacle3 Auto-Planning module (Philips Medical Systems, Fitchburg, WI, USA). The anatomic distance between the second clinical target volume (CTV2) and the pons of the brainstem, and the T category of disease were factored into the evaluation. Dosimetric verification was evaluated in terms of gamma pass rate. Target coverage, sparing of organs at risk (OARs), and monitor units were evaluated and compared between the manual and automatic VMAT plans.

Results

Not all treatment plans fully met the dose objectives for planning target volumes (PTVs) and OARs, particularly in T4 patients. Overall, automatic VMAT provides a comparable or superior plan quality to manual VMAT in most cases. In stratified analysis, plan quality is mainly independent on T category but is also affected by anatomic distance. If the anatomic distance is less than 5 mm, the automatic VMAT plan quality is equal or even inferior to manual VMAT performed by experienced physicists. Conversely, if the anatomic distance is greater than 5 mm, the automatic VMAT plan quality is superior to manual VMAT. Gamma pass rates for quality assurance are similar between manual and automatic VMAT plans for the former case, but significantly higher in automatic VMAT for the latter.

Conclusion

The selection of manual versus automatic VMAT planning in locally advanced NPC should be made individually based on the anatomic distance, rather than blindly and habitually, since automatic VMAT is not good enough to completely replace manual VMAT.

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Funding

This work was supported financially by Guangzhou Key Medical Discipline Construction Project Fund, Technology Project of Guangzhou Medical and Health Science (Grant Number: 20181A011095).

Author information

Authors and Affiliations

  1. Radiotherapy center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China

    Quanbin Zhang, Yingying Peng, Hui Yu, Linjing Wang & Shuxu Zhang

  2. Guangzhou Medical University, Guangzhou, China

    Liya Ou

Authors
  1. Quanbin Zhang
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  2. Liya Ou
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  3. Yingying Peng
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  4. Hui Yu
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  5. Linjing Wang
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  6. Shuxu Zhang
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Contributions

All authors participated in patient treatment and were involved in preparation of the manuscript. Q.Z., L.O., and S.Z. were responsible for the primary concept and design of the study; Y.P. and H.Y. planned and performed the experiments; Q.Z. and L.W. performed the data capture and analysis; Q.Z. and L.O. drafted and wrote the manuscript. All authors reviewed and approved the final manuscript. L.O. and S.Z. share corresponding authorship.

Corresponding authors

Correspondence to Liya Ou or Shuxu Zhang.

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Conflict of interest

Q. Zhang, L. Ou, Y. Peng, H. Yu, L. Wang, and S. Zhang declare that they have no competing interests.

Ethical standards

All experimental protocols of this study were approved by the Institutional Review Board of the Affiliated Cancer Hospital and Institute of Guangzhou Medical University. All patients included into this study had given their approval to use their data for scientific research. All personal information to identify patients was removed from the image data and analyzed retrospectively.

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Zhang, Q., Ou, L., Peng, Y. et al. Evaluation of automatic VMAT plans in locally advanced nasopharyngeal carcinoma. Strahlenther Onkol 197, 177–187 (2021). https://doi.org/10.1007/s00066-020-01631-x

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  • DOI: https://doi.org/10.1007/s00066-020-01631-x

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