Prostate intensity-modulated radiotherapy planning in seven mouse clicks: Development of a class solution for cancer

Abstract

Aim

The aim of the retrospective study was to develop a planning class solution for prostate intensity-modulated radiotherapy (IMRT) that achieved target and organs-at-risk (OAR) doses within acceptable departmental protocol criteria using the Monaco treatment planning system (Elekta-CMS Software, MO, USA).

Background

Advances in radiation therapy technology have led to a re-evaluation of work practices. Class solutions have the potential to produce highly conformal plans in a time-efficient manner.

Materials and Methods

Using data from intermediate and high risk prostate cancer patients, a stepwise quality improvement model was employed. Stage 1 involved the development of a broadly based treatment template developed across 10 patients. Stage 2 involved template refinement and clinical audit (n[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]20); Stage 3, template review (n[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]50) and Stage 4 an assessment of a revised template against the actual treatment plan involving 72 patients.

Results

The computer algorithm that comprised the Stage 4 template met clinical treatment criteria for 82% of patients. Minor template changes were required for a further 13% of patients. Major changes were required in 4%; one patient could not be assessed. The average calculation time was 13[[ce:hsp sp="0.25"/]]min and involved seven mouse clicks by the planner. Thus, the new template met treatment criteria or required only minor changes in 95% of prostate patients; this is an encouraging result suggesting improvements in planning efficiency and consistency.

Conclusion

It is feasible to develop a class solution for prostate IMRT using a stepwise quality improvement model which delivers clinically acceptable plans in the great majority of prostate cases.