Planning Benchmark Study for Stereotactic Body Radiation Therapy of Liver Metastases: Results of the DEGRO/DGMP Working Group on Stereotactic Radiation Therapy and Radiosurgery

Christos Moustakis; Oliver Blanck; Mark Ka Heng Chan; Judit Boda-Heggemann; Nicolaus Andratschke; Marciana-Nona Duma; Dirk Albers; Christian Bäumer; Roman Fehr; Stefan A Körber; Daniel Schmidhalter; Manfred Alraun; Wolfgang W Baus; Eric Beckers; Mathias Dierl; Stephan Droege; Fatemeh Ebrahimi Tazehmahalleh; Jens Fleckenstein; Matthias Guckenberger; Christian Heinz; Christoph Henkenberens; Andreas Hennig; Janett Köhn; Christine Kornhuber; Thomas Krieger; Britta Loutfi-Krauss; Manfred Mayr; Markus Oechsner; Tina Pfeiler; Gerhard Pollul; Jürgen Schöffler; Heiko Tümmler; Claudia Ullm; Mathias Walke; Rocco Weigel; Martin Wertman; Rolf Wiehle; Tilo Wiezorek; Lotte Wilke; Ulrich Wolf; Hans Theodor Eich; Daniela Schmitt

doi:10.1016/j.ijrobp.2022.01.008

Planning Benchmark Study for Stereotactic Body Radiation Therapy of Liver Metastases: Results of the DEGRO/DGMP Working Group on Stereotactic Radiation Therapy and Radiosurgery

Int J Radiat Oncol Biol Phys. 2022 May 1;113(1):214-227. doi: 10.1016/j.ijrobp.2022.01.008. Epub 2022 Jan 22.

Authors

Christos Moustakis¹, Oliver Blanck², Mark Ka Heng Chan³, Judit Boda-Heggemann⁴, Nicolaus Andratschke⁵, Marciana-Nona Duma⁶, Dirk Albers⁷, Christian Bäumer⁸, Roman Fehr⁹, Stefan A Körber¹⁰, Daniel Schmidhalter¹¹, Manfred Alraun¹², Wolfgang W Baus¹³, Eric Beckers¹⁴, Mathias Dierl¹⁵, Stephan Droege¹⁶, Fatemeh Ebrahimi Tazehmahalleh¹⁷, Jens Fleckenstein⁴, Matthias Guckenberger⁵, Christian Heinz¹⁸, Christoph Henkenberens¹⁹, Andreas Hennig²⁰, Janett Köhn²¹, Christine Kornhuber²², Thomas Krieger²³, Britta Loutfi-Krauss²¹, Manfred Mayr²⁴, Markus Oechsner²⁵, Tina Pfeiler⁸, Gerhard Pollul²⁶, Jürgen Schöffler²⁷, Heiko Tümmler²⁸, Claudia Ullm²⁹, Mathias Walke³⁰, Rocco Weigel³¹, Martin Wertman³², Rolf Wiehle³³, Tilo Wiezorek³⁴, Lotte Wilke⁵, Ulrich Wolf³⁵, Hans Theodor Eich³⁶, Daniela Schmitt³⁷

Affiliations

¹ Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany. Electronic address: [email protected].
² Department of Radiation Oncology, University Medical Center Schleswig Holstein, Kiel, Germany; Saphir Radiosurgery Center, Frankfurt and Northern Germany, Kiel, Germany.
³ Department of Radiation Oncology, University Medical Center Schleswig Holstein, Kiel, Germany.
⁴ Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany.
⁵ Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁶ Department of Radiation Oncology, University Hospital Rechts der Isar, Technical University, Munich, Germany; Department of Radiation Oncology, University Hospital Jena, Jena, Germany.
⁷ Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁸ West German Proton Therapy Centre, Essen, Germany.
⁹ Department of Radiation Oncology, University Medicine Rostock, Rostock, Germany.
¹⁰ Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
¹¹ Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
¹² Department of Radiation Oncology, Schwarzwald-Baar Hospital, Villingen-Schwenningen, Germany.
¹³ Department of Radiation Oncology, University Hospital Cologne, Cologne, Germany.
¹⁴ Gamma Knife Center Krefeld, Krefeld, Germany.
¹⁵ Department of Radiation Oncology, Hospital Bayreuth, Bayreuth, Germany.
¹⁶ Department of Radiation Oncology, Lung Clinic Hemer, Hemer, Germany.
¹⁷ Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany; Department of Radiation Oncology, University Hospital Cologne, Cologne, Germany.
¹⁸ Department of Radiation Oncology, University Hospital Munich, LMU Munich, Munich, Germany.
¹⁹ Department of Radiation Oncology, Medical University Hannover, Hannover, Germany.
²⁰ Private Practice for Radiation Oncology, Distler Bautzen, Germany.
²¹ Saphir Radiosurgery Center, Frankfurt and Northern Germany, Kiel, Germany; Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt, Germany.
²² Department of Radiation Oncology, University Hospital Halle, Halle (Saale), Germany.
²³ Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany.
²⁴ Private Practice for Radiation Oncology South, Kaufbeuren, Germany.
²⁵ Department of Radiation Oncology, University Hospital Rechts der Isar, Technical University, Munich, Germany.
²⁶ Department of Radiation Oncology, University Hospital Mainz, Mainz, Germany.
²⁷ Private Practice for Radiation Oncology, Boeblingen, Germany.
²⁸ Private Practice for Radiation Oncology, Dresden, Germany.
²⁹ Radiologie Muenchen, Private Practice for Radiation Oncology, Munich, Germany.
³⁰ Department of Radiation Oncology, University Hospital Magdeburg, Magdeburg, Germany.
³¹ Department of Radiation Oncology, University Hospital Innsbruck, Innsbruck, Austria.
³² Department of Radiation Oncology, University Medicine Rostock, Rostock, Germany; Department of Radiation Oncology, Ernst von Bergmann Hospital, Potsdam, Germany.
³³ Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany.
³⁴ Department of Radiation Oncology, University Hospital Jena, Jena, Germany.
³⁵ Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany.
³⁶ Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany.
³⁷ Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Department of Radiation Oncology, University Medical Center Goettingen, Goettingen, Germany.

PMID: 35074434
DOI: 10.1016/j.ijrobp.2022.01.008

Abstract

Purpose: Our purpose was to investigate whether liver stereotactic body radiation therapy treatment planning can be harmonized across different treatment planning systems, delivery techniques, and institutions by using a specific prescription method and to minimize the knowledge gap concerning intersystem and interuser differences. We provide best practice guidelines for all used techniques.

Methods and materials: A multiparametric specification of target dose (gross target volume [GTV]_D50%, GTV_D0.1cc, GTV_V90%, planning target volume [PTV]_V70%) with a prescription dose of GTV_D50% = 3 × 20 Gy and organ-at-risk (OAR) limits were distributed with computed tomography and structure sets from 3 patients with liver metastases. Thirty-five institutions provided 132 treatment plans using different irradiation techniques. These plans were first analyzed for target and OAR doses. Four different renormalization methods were performed (PTV_Dmin, PTV_D98%, PTV_D2%, PTV_Dmax). The resulting 660 treatments plans were evaluated regarding target doses to study the effect of dose renormalization to different prescription methods. A relative scoring system was used for comparisons.

Results: GTV_D50% prescription can be performed in all systems. Treatment plan harmonization was overall successful, with standard deviations for D_max, PTV_D98%, GTV_D98%, and PTV_Dmean of 1.6, 3.3, 1.9, and 1.5 Gy, respectively. Primary analysis showed 55 major deviations from clinical goals in 132 plans, whereas in only <20% of deviations GTV/PTV dose was traded for meeting OAR limits. GTV_D50% prescription produced the smallest deviation from target planning objectives and between techniques, followed by the PTV_Dmax, PTV_D98%, PTV_D2%, and PTV_Dmin prescription. Deviations were significant for all combinations but for the PTV_Dmax prescription compared with GTV_D50% and PTV_D98%. Based on the various dose prescription methods, all systems significantly differed from each other, whereas GTV_D50% and PTV_D98% prescription showed the least difference between the systems.

Conclusions: This study showed the feasibility of harmonizing liver stereotactic body radiation therapy treatment plans across different treatment planning systems and delivery techniques when a sufficient set of clinical goals is given.

MeSH terms

Benchmarking
Humans
Liver Neoplasms* / diagnostic imaging
Liver Neoplasms* / radiotherapy
Radiosurgery* / methods
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted / methods
Radiotherapy, Intensity-Modulated* / methods