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A first-in-human randomized clinical trial of graphics processing units based multi-criteria optimization (gMCO)
F Lacroix1, E Poulin2, C Bélanger2
1Service de Physique Médicale et Radioprotection, CHU de Québec, Québec, Quebec, Canada.
Purpose:
The purpose of this work, a first-in-human randomized clinical trial, was to compare gMCO, a GPU-based multi criteria optimization (MCO) algorithm, to reference plans in terms of planning time and plan quality for prostate HDR brachytherapy.
Methods And Materials:
The brachytherapy procedure was as follows: (1) Patient installation, (2) Catheter implantation under transrectal ultrasound (US) guidance, (3) 3D US scan, (4) Contouring/catheter reconstruction on Oncentra Prostate (Elekta, Veenendaal, Netherlands), (5) Planning, (6) Treatment. Planning (step 5) was performed, after randomization, using either IPSA (Oncentra Prostate, Veenendaal, Netherlands) or gMCO. The planning times on IPSA or gMCO were recorded. Patients previously had a planning MR in order to identify whether a gross tumor volume (GTV, PIRADS 3 and above) was visible and, if present, the GTV was boosted to a minimum of 19 Gy of the prescription dose. Fifty-five patients were accrued and distributed randomly between both treatment arms. Dosimetric indices (Prostate V100, V150, V200, GTV D90, Urethra D10, Rectum and Bladder V75 and D1cc) of gMCO and Inverse-Planning Simulated Annealing algorithm (IPSA) plans were compared to determine if plan quality and planning times were statistically different.
Results:
Results show that the optimization time is reduced by half when using gMCO as compared to IPSA, going from 10-5.2 minutes. Although no statistically significant difference is present between gMCO and IPSA plans when comparing pairs of individual dosimetric indices, gMCO plans exhibit a higher pass rate (higher by a factor ranging from 1.3 to 1.6), as compared to IPSA, when considering a basket of dosimetric indices simultaneously.
Conclusion:
The use of gMCO halves the planning time for prostate HDR brachytherapy as compared to IPSA, without decreasing plan quality. The overall gain in efficiency related to the planning process has led to the use of gMCO for all of our HDR prostate cases.
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