Late toxicity in the randomized multicenter HYPRO trial for prostate cancer analyzed with automated treatment planning

Assess to what extent the use of automated treatment planning would have reduced organ-at-risk dose delivery observed in the randomized HYPRO trial for prostate cancer, and estimate related toxicity reductions. Investigate to what extent improved plan quality for hypofractionation scheme as achieved...

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Bibliographic Details
Published in:Radiotherapy and oncology 2018-08, Vol.128 (2), p.349-356
Main Authors: Sharfo, Abdul Wahab M., Dirkx, Maarten L.P., Bijman, Rik G., Schillemans, Wilco, Breedveld, Sebastiaan, Aluwini, Shafak, Pos, Floris, Incrocci, Luca, Heijmen, Ben J.M.
Format: Article
Language:English
Subjects:
Aged
Algorithms
Automated planning
Dose Fractionation, Radiation
Humans
IMRT
Male
Middle Aged
NTCP
Probability
Prostate cancer
Prostatic Neoplasms - radiotherapy
Radiation Dose Hypofractionation
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted - methods
Radiotherapy, Intensity-Modulated - adverse effects
Rectum - radiation effects
Toxicity
Urinary Bladder - radiation effects
VMAT
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Summary:Assess to what extent the use of automated treatment planning would have reduced organ-at-risk dose delivery observed in the randomized HYPRO trial for prostate cancer, and estimate related toxicity reductions. Investigate to what extent improved plan quality for hypofractionation scheme as achieved with automated planning can potentially reduce observed enhanced toxicity for the investigated hypofractionation scheme to levels observed for conventional fractionation scheme. For 725 trial patients, VMAT plans were generated with an algorithm for automated multi-criterial plan generation (autoVMAT). All clinically delivered plans (CLINICAL), generated with commonly applied interactive trial-and-error planning were also available for the investigations. Analyses were based on dose-volume histograms (DVH) and predicted normal tissue complication probabilities (NTCP) for late gastrointestinal (GI) toxicity. Compared to CLINICAL, autoVMAT plans had similar or higher PTV coverage, while large and statistically significant OAR sparing was achieved. Mean doses in the rectum, anus and bladder were reduced by 7.8 ± 4.7 Gy, 7.9 ± 6.0 Gy and 4.2 ± 2.9 Gy, respectively (p 
ISSN:0167-8140
1879-0887
DOI:10.1016/j.radonc.2018.05.028