Fully automatic treatment planning for external-beam radiation therapy of locally advanced cervical cancer : a tool for low-resource clinics
Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
American Society of Clinical Oncology
Abstract
PURPOSE: The purpose of this study was to validate a fully automatic treatment planning system for
conventional radiotherapy of cervical cancer. This system was developed to mitigate staff shortages in low-resource clinics.
METHODS: In collaboration with hospitals in South Africa and the United States, we have developed
the Radiation Planning Assistant (RPA), which includes algorithms for automating every step of
planning: delineating the body contour, detecting the marked isocenter, designing the
treatment-beam apertures, and optimizing the beam weights to minimize dose heterogeneity. First, we
validated the RPA retrospectively on 150 planning computed tomography (CT) scans. We then tested it
remotely on 14 planning CT scans at two South African hospitals. Finally, automatically planned
treatment beams were clinically deployed at our institution.
RESULTS: The automatically and manually delineated body contours agreed well (median mean surface
dis- tance, 0.6 mm; range, 0.4 to 1.9 mm). The automatically and manually detected marked
isocenters agreed well (mean difference, 1.1 mm; range, 0.1 to 2.9 mm). In validating the
automatically designed beam apertures, two physicians, one from our institution and one from a
South African partner institution, rated 91% and 88% of plans acceptable for treatment,
respectively. The use of automatically optimized beam weights reduced the maximum dose significantly
(median, −1.9%; P , .001). Of the 14 plans from South Africa, 100% were rated clinically
acceptable. Automatically planned treatment beams have been used for 24 patients with cervical
cancer by physicians at our institution, with edits as needed, and its use is ongoing.
CONCLUSION: We found that fully automatic treatment planning is effective for cervical cancer
radiotherapy and may provide a reliable option for low-resource clinics. Prospective studies are
ongoing in the United States and
are planned with partner clinics.
Description
CITATION: Kisling, K., et al. 2019. Fully automatic treatment planning for external-beam radiation therapy of locally advanced cervical cancer : a tool for low-resource clinics. Journal of Global Oncology, 5:1-7, doi:10.1200/JGO.18.00107.
The original publication is available at https://ascopubs.org/
The original publication is available at https://ascopubs.org/
Keywords
Cervix uteri -- Cancer -- Radiotherapy -- Developing countries, Photon beam radiation therapy -- Developing countries, Photon beam radiation therapy -- Strategic planning, Radiotherapy -- Strategic planning
Citation
Kisling, K., et al. 2019. Fully automatic treatment planning for external-beam radiation therapy of locally advanced cervical cancer : a tool for low-resource clinics. Journal of Global Oncology, 5:1-7, doi:10.1200/JGO.18.00107