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Clinical evaluation of a real-time inverse planning for Gamma Knife radiosurgery by convex optimization: a prospective comparative trial in a series of vestibular schwannoma patients

  • Original Article - Brain Tumors
  • Published:
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Abstract

Background

Gamma Knife radiosurgery (GKRS) inverse dose planning is currently far from competing effectively with the quality of dose planning developed by experienced experts. A new inverse planning (IP) method based on « efficient convex optimization algorithms » is proposed, providing high-quality dose plans in real time.

Materials and methods

Eighty-six patients treated by GKRS for vestibular schwannomas (VS) were recruited. The treatment plans created by the first author, who has 27 years of experience and has developed and delivered more than 15,000 dose plans, served as reference. A first set of basic constraints determined by default led the IP for an initial real-time dose plan. Additional constraints were interactively proposed by the planner to take other parameters into account. A second optimized plan was then calculated by the IP. The primary endpoint was the Paddick Conformity Index (PCI). The statistical analysis was planned on a non-inferiority trial design. Coverage, selectivity, and gradient indexes, dose at the organ(s) at risk, and 12 Gy isodose line volume were compared.

Results

After a single run of the IP, the PCI was shown to be non-inferior to that of the “expert.” For the expert and the IP, respectively, the median coverage index was 0.99 and 0.98, the median selectivity index 0.92 and 0.90, the median gradient index 2.95 and 2.84, the median dose at the modiolus of the cochlea 2.83 Gy and 2.86 Gy, the median number of shots 14.31 and 24.13, and the median beam-on time 46.20 min and 26.77 min. In a few specific cases, advanced tools of the IP were used to generate a second run by adding new constraints either globally (for higher selectivity) or locally, in order to increase or decrease these constraints focally.

Conclusion

These preliminary results showed that this new IP method based on « efficient convex optimization algorithms », called IntuitivePlan®, provided high-quality dose plans in real time with excellent coverage, selectivity, and gradient indexes with optimized beam-on time. If the new IP evaluated here is able to compete in real time with the quality of the treatment plans of an expert with extensive radiosurgical experience, this could allow new planners/radiosurgeons with limited or no experience to immediately provide patients with high-quality GKRS for benign and malignant lesions.

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Funding

APHM (Assistance Public Hopitaux de Marseille) provided financial support by paying the insurances. This work was supported by Intuitive Therapeutics through a research grant. The sponsor had no role in the design of this research, nor in how it was conducted.

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Authors and Affiliations

  1. Institut de Neuroscience des Systèmes, Functional Neurosurgery and Radiosurgery Department, Aix-Marseille Université, Hôpital de la Timone, APHM, Marseille, France

    Jean Régis, Hussein Hamdi, Louise Merly, Laura Castillo, Anne Balossier & Giorgio Spatola

  2. Service de Neurochirurgie Fonctionnelle & Radiochirurgie, Hôpital d’adulte de la Timone, 264 Bvd Saint Pierre, 13 285, Marseille Cedex 05, France

    Jean Régis

  3. Departement of Biostatistic, Aix-Marseille Université, Marseille, France

    Anderson Loundou

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  1. Jean Régis
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  2. Hussein Hamdi
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  3. Anderson Loundou
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  4. Louise Merly
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  5. Laura Castillo
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  6. Anne Balossier
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  7. Giorgio Spatola
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Correspondence to Jean Régis.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript with the exception of Jean Régis who is a consultant for and has received a research grant from Elekta, AB & Medtronic.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (CPPRB: Comité de Protection des Personnes pour la recherche en Biologie) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The ethics committee authorized this study on the November 11, 2017, under the name « Original title in French: Protocole d’évaluation d’un algorithme de planification pour la radiochirurgie par Gamma Knife (SPEED) » under the registration number 2017-A02753-50 (NTC03520829). This was a non-interventional, single center, and prospective observational study.

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Informed consent was obtained from all individual participants included in the study.

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Régis, J., Hamdi, H., Loundou, A. et al. Clinical evaluation of a real-time inverse planning for Gamma Knife radiosurgery by convex optimization: a prospective comparative trial in a series of vestibular schwannoma patients. Acta Neurochir 163, 981–989 (2021). https://doi.org/10.1007/s00701-020-04695-x

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  • DOI: https://doi.org/10.1007/s00701-020-04695-x

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