Automatic treatment planning improves the clinical quality of head and neck cancer treatment plans

Highlights

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  Autoplan can produce clinically better VMAT radiotherapy plans for H&N cancer.

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  Autoplan plans have similar target coverage with significant sparing of OAR.

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  With a template the TPS can automatically create better plans than manually created plans.

Abstract

Background

Treatment plans for head and neck (H&N) cancer are highly complex due to multiple dose prescription levels and numerous organs at risk (OARs) close to the target. The plan quality is inter-planner dependent since it is dependent on the skills and experience of the dosimetrist. This study presents a blinded prospective clinical comparison of automatic (AU) and manually (MA) generated H&N VMAT plans made for clinical use.

Methods

MA and AU plans were generated for 30 consecutive patients in Pinnacle ³ using the IMRT optimisation module and the new Autoplan module, respectively. The plan quality was blindedly compared by three senior oncologists and the best plan was selected for treatment of the patient. Planning time was measured as the active operator time used. The plan quality was analysed with DVH metrics and the dose delivery accuracy validated on the ArcCheck phantom.

Results

For twenty-nine out of the thirty patients the AU plan was chosen for treatment. Target doses were more homogenous with the AU plans and the OAR doses were significantly reduced, between 0.5 and 6.5 Gy. The average operator time spent on creating a manual plan was 64 min which was halved by Autoplan. The AU plans were more modulated as illustrated by an increase in MUs, which might cause the slightly lower pass rate of 97.7% in the ArcCheck measurements.

Conclusions

Target doses were similar between MA and AU plan, while AU plans spared all OAR considerably better than the MA plans.