Planning Benchmark Study for Stereotactic Body Radiation Therapy of Pancreas Carcinomas With Simultaneously Integrated Boost and Protection: Results of the DEGRO/DGMP Working Group on Stereotactic Radiation Therapy and Radiosurgery

Moustakis C, Blanck O, Grohmann M, Albers D, Bartels D, Bathen B, Borzì GR, Broggi S, Bruschi A, Casale M, Delana A, Doolan P, Ebrahimi Tazehmahalleh F, Fabiani S, Falco MD, Fehr R, Friedlein M, Gutser S, Hamada AM, Hancock T, Köhn J, Kornhuber C, Krieger T, Lambrecht U, Lappi S, Moretti E, Mirus A, Muedder T, Plaude S, Polvika B, Ravaglia V, Righetto R, Rinaldin G, Schachner H, Scaggion A, Schilling P, Szeverinski P, Villaggi E, Walke M, Wilke L, Winkler P, Nicolay NH, Eich HT, Gkika E, Brunner TB, Schmitt D (2024)

Publication Type: Journal article

Publication year: 2024

Journal

DOI: 10.1016/j.ijrobp.2024.08.038

Abstract

Purpose: The proximity or overlap of planning target volume (PTV) and organs-at-risk (OARs) poses a major challenge in stereotactic body radiation therapy (SBRT) of pancreatic cancer (PACA). This international treatment planning benchmark study investigates whether simultaneous integrated boost (SIB) and simultaneous integrated protection (SIP) concepts in PACA SBRT can lead to improved and harmonized plan quality. Methods and Materials: A multiparametric specification of desired target doses (gross target volume [GTV]D50%, GTVD99%, PTVD95%, and PTV0.5cc) with 2 prescription doses of GTVD50% = 5 × 9.2Gy (46 Gy) and GTVD50% = 8 × 8.25 Gy (66 Gy) and OAR limits were distributed with planning computed tomography and contours from 3 PACA patients. In phase 1, plans were ranked using a scoring system for comparison of trade-offs between GTV/PTV and OAR. In phase 2, replanning was performed for the most challenging case and prescription with dedicated SIB and SIP contours provided for optimization after group discussion. Results: For all 3 cases and both phases combined, 292 plans were generated from 42 institutions in 5 countries using commonly available treatment planning systems. The GTVD50% prescription was performed by only 76% and 74% of planners within 2% for 5 and 8 fractions, respectively. The GTVD99% goal was mostly reached, while the balance between OAR and target dose showed initial SIB/SIP-like optimization strategies in about 50% of plans. For plan ranking, 149 and 217 score penalties were given for 5 and 8 fractions, pointing to improvement possibilities. For phase 2, the GTVD50% prescription was performed by 95% of planners within 2%, and GTVD99% as well as OAR doses were better harmonized with notable less score penalties. Fourteen of 19 planners improved their plan rank, 9 of them by at least 2 ranks. Conclusions: Dedicated SIB/SIP concepts in combination with multiparametric prescriptions and constraints can lead to overall harmonized and high treatment plan quality for PACA SBRT. Standardized SIB/SIP treatment planning in multicenter clinical trials appears feasible after group consensus and training.

Involved external institutions

Casa di Cura San Rossore Italy (IT) AUSL Piacenza Italy (IT) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Universitätsklinikum Augsburg Germany (DE) Hospital Santa Maria Italy (IT) Ospedale Santa Chiara Italy (IT) Azienda sanitaria universitaria Friuli Centrale (ASU FC) Italy (IT) Universitätsspital Zürich (USZ) Switzerland (CH) Universitätsklinikum Magdeburg A.ö.R. Germany (DE) Universitätsklinikum Jena Germany (DE) Universitätsklinikum Leipzig Germany (DE) Istituto Oncologico Veneto (IOV), IRCCS Italy (IT) Universitätsklinikum Würzburg Germany (DE) Universitätsklinikum Frankfurt am Main (KGU) Germany (DE) Krankenhaus Dresden-Friedrichstadt, Städtisches Klinikum Germany (DE) Kantonsspital Aarau AG Switzerland (CH) Medizinische Universität Graz Austria (AT) Universitätsklinikum Bonn Germany (DE) HELIOS Kliniken Germany (DE) Kantonsspital Graubünden Switzerland (CH) Charité - Universitätsmedizin Berlin Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Ospedale San Raffaele (früher: Centro San Raffaele del Monte Tabor Foundation) Italy (IT) Landeskrankenhaus Feldkirch Austria (AT) Universitätsklinikum Halle (Saale) Germany (DE) Universitätsklinikum Münster Germany (DE) AUSL Romagna Italy (IT) Universitätsmedizin Rostock Germany (DE) Humanitas Istituto Clinico Catanese Italy (IT) German Medical Institute Cyprus (CY) Università degli Studi Gabriele D'Annunzio Italy (IT) Universitätsklinikum Essen Germany (DE) Universitätsklinikum Göttingen Germany (DE)

How to cite

APA:

Moustakis, C., Blanck, O., Grohmann, M., Albers, D., Bartels, D., Bathen, B.,... Schmitt, D. (2024). Planning Benchmark Study for Stereotactic Body Radiation Therapy of Pancreas Carcinomas With Simultaneously Integrated Boost and Protection: Results of the DEGRO/DGMP Working Group on Stereotactic Radiation Therapy and Radiosurgery. International Journal of Radiation Oncology Biology Physics. https://doi.org/10.1016/j.ijrobp.2024.08.038

MLA:

Moustakis, Christos, et al. "Planning Benchmark Study for Stereotactic Body Radiation Therapy of Pancreas Carcinomas With Simultaneously Integrated Boost and Protection: Results of the DEGRO/DGMP Working Group on Stereotactic Radiation Therapy and Radiosurgery." International Journal of Radiation Oncology Biology Physics (2024).

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