Evaluating the application of Pareto navigation guided automated radiotherapy treatment planning to prostate cancer.

Abstract

Current automated planning methods do not allow for the intuitive exploration of clinical trade-offs during calibration. Recently a novel automated planning solution, which is calibrated using Pareto navigation principles, has been developed to address this issue. The purpose of this work was to clinically validate the solution for prostate cancer patients with and without elective nodal irradiation. For 40 randomly selected patients (20 prostate and seminal vesicles (PSV) and 20 prostate and pelvic nodes (PPN)) automatically generated volumetric modulated arc therapy plans (VMAT_Auto) were compared against plans created by expert dosimetrists under clinical conditions (VMAT_Clinical) and no time pressures (VMAT_Ideal). Plans were compared through quantitative comparison of dosimetric parameters and blind review by an oncologist. Upon blind review 39/40 and 33/40 VMAT_Auto plans were considered preferable or equal to VMAT_Clinical and VMAT_Ideal respectively, with all deemed clinically acceptable. Dosimetrically, VMAT_Auto, VMAT_Clinical and VMAT_Ideal were similar, with observed differences generally of low clinical significance. Compared to VMAT_Clinical, VMAT_Auto reduced hands-on planning time by 94% and 79% for PSV and PPN respectively. Total planning time was significantly reduced from 22.2 mins to 14.0 mins for PSV, with no significant reduction observed for PPN. A novel automated planning solution has been evaluated, whose Pareto navigation based calibration enabled clinical decision-making on trade-off balancing to be intuitively incorporated into automated protocols. It was successfully applied to two sites of differing complexity and robustly generated high quality plans in an efficient manner.