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RapidPlan Knowledge-Based Radiotherapy Planning Compared to Manual Planning in Locally Advanced Non-Small-Cell Lung

Tal Falick Michaeli1,2, Tamar Abu Said1, Stanislav Raskin1

  • 1Department of Radiation Oncology, Sharett Institute of Oncology Hadassah Medical Center, Jerusalem 91120, Israel.

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Summary
This summary is machine-generated.

RapidPlan (RP) knowledge-based planning significantly improved organ-at-risk sparing for stage III non-small cell lung cancer (NSCLC) patients, reducing heart and esophageal doses. Lung toxicity remained a concern, impacting overall survival.

Keywords:
IMRTRapidPlan (RP)VMATdosimetric outcomesorgans-at-risk (OARs)stage III NSCLC

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Oncology

Background:

  • Stage III non-small cell lung cancer (NSCLC) treatment planning faces dosimetric challenges due to critical structure proximity.
  • Knowledge-based planning (KBP) systems like RapidPlan (RP) offer potential for improved consistency and organ-at-risk (OAR) sparing.

Purpose of the Study:

  • To compare dosimetric and clinical outcomes of RP-generated plans versus manually optimized plans in stage III NSCLC patients.
  • To evaluate the efficacy of RP in intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) for NSCLC.

Main Methods:

  • Retrospective analysis of 50 patients with stage III NSCLC treated with concurrent chemoradiation.
  • Comparison of RP-generated plans (using a lung-specific model) with original manual clinical plans within the Eclipse treatment planning system.
  • Evaluation of dosimetric parameters, toxicity, survival outcomes, and Normal Tissue Complication Probability (NTCP) modeling.

Main Results:

  • RP significantly reduced mean heart dose (-2.54 Gy), spinal cord maximum dose (-4.08 Gy), and esophageal mean dose (-3.89 Gy) compared to manual plans.
  • RP plans showed slightly higher lung doses (V20 +2.12%), with VMAT-RP plans offering superior cardiac and esophageal sparing.
  • RP reduced NTCP for the heart (0.34% to 0.20%) and esophagus (16.6% to 11.5%), but not for lung or spinal cord. Lung toxicity (≥ grade 2) was linked to reduced overall survival (16.2 vs. 51.8 months).

Conclusions:

  • RapidPlan-based KBP enhances OAR sparing while maintaining target coverage in locally advanced NSCLC.
  • Slight increases in lung dose necessitate ongoing model refinement for RP.
  • The observed association between lung toxicity and reduced survival highlights the impact of treatment-related morbidity on patient outcomes.