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Fluence smoothing evaluation for whole-breast automatically generated treatment plans.

Giulianne Rivelli R Zaratim^1,2, Luis Felipe Oliveira E Silva^2,3, Ricardo G Dos Reis^1,3

¹Department of Biomedical Engineering, University of Brasilia, Brasília, Brazil.

Journal of Applied Clinical Medical Physics

|November 29, 2024

Summary

Optimizing fluence smoothing in breast cancer intensity-modulated radiation therapy (IMRT) is key. A smoothing weight to target priority ratio of 1:1.5 to 1:1.6 balances plan complexity and dosimetric quality without compromising dose adherence.

Keywords:

IMRT automated treatment planning breast cancer complexity fluence smoothing

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Area of Science:

Medical Physics
Radiation Oncology
Radiotherapy Planning

Background:

Intensity-modulated radiation therapy (IMRT) is a standard treatment for breast cancer.
Fluence smoothing is a critical step in IMRT planning to reduce dose complexity.
Optimizing smoothing parameters is essential for maintaining dosimetric quality and treatment efficacy.

Purpose of the Study:

To determine the optimal fluence smoothing threshold for breast cancer IMRT.
To evaluate the impact of different smoothing weight combinations on dosimetric plan quality.
To identify a balance between treatment plan complexity and adherence to dose constraints.

Main Methods:

Automated treatment planning for 60 breast cancer patients using the Eclipse Scripting Application Programming Interface.
Four-field IMRT plans were generated with four different smoothing weight sets.
Dosimetric data, including planning target volume (PTV) coverage and organ-at-risk (OAR) constraints, were statistically analyzed.

Main Results:

Default smoothing (40x30) provided superior median PTV coverage.
Higher smoothing levels significantly impacted lung constraints and reduced monitor units.
Heart and contralateral breast constraints showed minimal variation across smoothing levels, with some exceptions for right-sided patients.
A smoothing weight to target priority ratio between 1:1.5 and 1:1.6 demonstrated favorable outcomes.

Conclusions:

A smoothing weight to target priority ratio of 1:1.5 to 1:1.6 offers an optimal balance for breast cancer IMRT.
This ratio ensures good dosimetric plan quality without negatively affecting dose constraint adherence.
The findings provide guidance for refining IMRT planning parameters to improve treatment outcomes.