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

Christos Moustakis; Oliver Blanck; Maximilian Grohmann; Dirk Albers; Dennis Bartels; Bastian Bathen; Giuseppina Rita Borzì; Sara Broggi; Andrea Bruschi; Michelina Casale; Anna Delana; Paul Doolan; Fatemeh Ebrahimi Tazehmahalleh; Stefania Fabiani; Maria Daniela Falco; Roman Fehr; Melissa Friedlein; Susanne Gutser; Abdul Malek Hamada; Timothy Hancock; Janett Köhn; Christine Kornhuber; Thomas Krieger; Ulrike Lambrecht; Sara Lappi; Eugenia Moretti; Annalena Mirus; Thomas Muedder; Sandija Plaude; Bernd Polvika; Valentina Ravaglia; Roberto Righetto; Giuseppe Rinaldin; Henrik Schachner; Alessandro Scaggion; Philipp Schilling; Philipp Szeverinski; Elena Villaggi; Mathias Walke; Lotte Wilke; Peter Winkler; Nils H Nicolay; Hans Theodor Eich; Eleni Gkika; Thomas B Brunner; Daniela Schmitt

doi:10.1016/j.ijrobp.2024.08.038

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

Int J Radiat Oncol Biol Phys. 2024 Sep 1:S0360-3016(24)03315-7. doi: 10.1016/j.ijrobp.2024.08.038. Online ahead of print.

Authors

Christos Moustakis¹, Oliver Blanck², Maximilian Grohmann³, Dirk Albers³, Dennis Bartels⁴, Bastian Bathen⁵, Giuseppina Rita Borzì⁶, Sara Broggi⁷, Andrea Bruschi⁸, Michelina Casale⁹, Anna Delana¹⁰, Paul Doolan¹¹, Fatemeh Ebrahimi Tazehmahalleh¹², Stefania Fabiani⁹, Maria Daniela Falco¹³, Roman Fehr¹⁴, Melissa Friedlein¹⁵, Susanne Gutser¹⁶, Abdul Malek Hamada¹⁴, Timothy Hancock¹⁷, Janett Köhn⁵, Christine Kornhuber¹⁸, Thomas Krieger¹⁹, Ulrike Lambrecht²⁰, Sara Lappi²¹, Eugenia Moretti²², Annalena Mirus²³, Thomas Muedder²⁴, Sandija Plaude²⁵, Bernd Polvika²⁶, Valentina Ravaglia²¹, Roberto Righetto²⁷, Giuseppe Rinaldin²⁸, Henrik Schachner²⁹, Alessandro Scaggion³⁰, Philipp Schilling³¹, Philipp Szeverinski³², Elena Villaggi³³, Mathias Walke³⁴, Lotte Wilke³⁵, Peter Winkler³⁶, Nils H Nicolay³⁷, Hans Theodor Eich³⁸, Eleni Gkika³⁹, Thomas B Brunner⁴⁰, Daniela Schmitt⁴¹

Affiliations

¹ University Hospital Leipzig, Department of Radiation Oncology, Leipzig, Germany; University Hospital Muenster, Department of Radiation Oncology, Muenster, Germany. Electronic address: [email protected].
² University Medical Center Schleswig Holstein, Kiel, Department of Radiation Oncology, Kiel, Germany; Saphir Radiosurgery Center, Frankfurt and Kiel, Germany.
³ Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁴ Department of Radiation Oncology Harburg, Hamburg, Germany.
⁵ Department of Radiation Oncology, University Hospital, Goethe University, Frankfurt, Germany; Saphir Radiosurgery Center, Frankfurt, Germany.
⁶ Humanitas ICC - Medical Physics Department, Misterbianco (CT), Italy.
⁷ IRCCS San Raffaele, Milano, Italy.
⁸ Casa di Cura San Rossore Pisa, Pisa, Italy.
⁹ "Santa Maria" Terni Hospital, Terni, Italy.
¹⁰ Medical Physics Unit, "S. Chiara" Hospital, Trento, Italy.
¹¹ German Oncology Center, Limassol, Cyprus.
¹² Helios Hospital Schwerin, Department of Radiation Oncology, Schwerin, Germany; University Hospital Cologne, Department of Radiation Oncology, Cologne, Germany.
¹³ Department of Radiation Oncology, "G.D'Annunzio" University, "SS.Annunziata" Hospital, Chieti, Italy.
¹⁴ University Medicine Rostock, Department of Radiation Oncology, Rostock, Germany.
¹⁵ Department of Radiation Oncology, University Hospital Jena, Jena, Germany.
¹⁶ Department of Radiation Oncology, University Hospital Augsburg, Augsburg, Germany.
¹⁷ Kantonsspital Aarau, Aarau, Switzerland.
¹⁸ University Hospital Halle, Department of Radiation Oncology, Halle (Saale), Germany.
¹⁹ Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany.
²⁰ Department of Radiation Oncology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
²¹ AUSL Romagna, Rimini, Italy.
²² SOC Fisica Sanitaria ASU FC, Udine, Italy.
²³ University Medical Center Charité CBF, Berlin, Germany.
²⁴ Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany.
²⁵ West German Proton Therapy Center Essen (WPE), Essen, Germany.
²⁶ Kantonsspital Graubünden, Chur, Switzerland.
²⁷ Proton Therapy Unit, S. Chiara Hospital - Azienda Provinciale per I Servizi Sanitari (APSS), Trento, Italy.
²⁸ Medical Physics Unit, AULSS2 Marca Trevigiana, Treviso, Italy.
²⁹ Department of Radiation Oncology at Weilheim Hospital, Weilheim, Germany.
³⁰ Veneto Institute of Oncology IOV - IRCCS, Padova, Italy.
³¹ Municipal Hospital Dresden-Friedrichstadt - MVZ Radiotherapy, Dresden, Germany.
³² Institute of Medical Physics, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
³³ AUSL Piacenza, Piacenza, Italy.
³⁴ University Hospital Magdeburg, Department of Radiation Oncology, Magdeburg, Germany.
³⁵ University Hospital Zürich, Department of Radiation Oncology, Zürich, Switzerland.
³⁶ University Medical Center Graz, Department of Radiation Oncology, Graz, Austria.
³⁷ University Hospital Leipzig, Department of Radiation Oncology, Leipzig, Germany; University Hospital of Freiburg, Department of Radiation Oncology, Freiburg, Germany.
³⁸ University Hospital Muenster, Department of Radiation Oncology, Muenster, Germany.
³⁹ Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany; University Hospital of Freiburg, Department of Radiation Oncology, Freiburg, Germany.
⁴⁰ University Hospital Magdeburg, Department of Radiation Oncology, Magdeburg, Germany; University Medical Center Graz, Department of Radiation Oncology, Graz, Austria.
⁴¹ University Medical Center Göttingen, Department of Radiation Oncology, Göttingen, Germany.

PMID: 39222825
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%, GTV_D99%, PTV_D95%, and PTV_0.5cc) with 2 prescription doses of GTV_D50% = 5 × 9.2Gy (46 Gy) and GTV_D50% = 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 GTV_D50% prescription was performed by only 76% and 74% of planners within 2% for 5 and 8 fractions, respectively. The GTV_D99% 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 GTV_D50% prescription was performed by 95% of planners within 2%, and GTV_D99% 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.