ESTRO 36 Abstract Book

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S285 ESTRO 36 2017
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S.J.M. Habraken1 , A.W. Sharfo1, J. Buijsen2, W.F.A.R.
Verbakel3, C.J.A. Haasbeek3, M.C. Ollers2, G.H.
Westerveld4, N. Van Wieringen 4, O. Reerink5, E.
Seravalli5, P.M. Braam6, M. Wendling6, T. Lacornerie7, X.
Mirabel7, R. Weytjens8, L. Depuydt8, S. Lang9, O.
Riesterer 9, K. Haustermans10, T. Depuydt10 , B.J.M.
Heijmen1, A. Méndez Romero1
1 Erasmus MC Cancer Institute, Department of Radiation
Oncology, Rotterdam, The Netherlands
2 MAASTRO Clinic, Department of Radiation Oncology,
Maastricht, The Netherlands
3 VU University Medical Center, Radiation Oncology,
Amsterdam, The Netherlands
4 Academic Medical Center, Radiotherapy, Amsterdam,
The Netherlands
5 University Medical Center Utrecht, Department of
Radiotherapy, Utrecht, The Netherlands
6 Radboud University Medical Center, Radiation Oncology,
Nijmegen, The Netherlands
7 Oscar Lambret Comprehensive Cancer Center, Academic
Radiation Therapy Department, Lille, France
8 GZA Sint-Augustinus, Radiotherapy, Wilrijk, Belgium
9 University Hospital Zürich, Department of Radiation
Oncology, Zürich, Switzerland
10 University Hospital Gasthuisberg, Radiation Oncology,
Leuven, Belgium
Purpose or Objective
The TRENDY trial is an international multi-center phase II
study in which patients with hepatocellular carcinoma
(HCC) are randomized between transarterial
chemoembolization in the standard arm and stereotactic
body radiation therapy (SBRT) in the experimental arm.
SBRT is delivered in six fractions with a total target dose
of 48-54 Gy. An extensive QA program has been
implemented, including prospective (prior to delivery)
feedback on treatment plans, generated in the
participating centers. For this feedback, the QA team uses
a platform for automated treatment plan generation and
planning CT-scans submitted by the centers. Here, we
report on the first experiences.
Material and Methods
Based on the trial constraints and objectives, including a
constraint on the NTCP for the healthy liver (NTCP ≤ 5%),
fully automated plan generation for HCC has been
implemented in a system for automatic prioritized multi-
criteria optimization of deliverable VMAT plans
(autoVMAT). Prior to treatment, participating centers
send the contoured CT-scan of a new patient to the QA
team. A plan is then automatically generated to be
compared with the plan that was generated in the centers,
using the common manual planning. Comparisons can
result in improvements of the latter plan, which will be
used clinically. The goal is to promote quality and
uniformity of the SBRT treatment, and thereby, clinical
outcome.
Results
AutoVMAT plans are compared to 19 manual treatment
plans, 12 from a dummy run, 5 from a clinical pilot, and 2
from trial patients. Since target coverage is similar for all
plans, we focus on OARs. Although some non-coplanar
Cyberknife plans outperform the corresponding co-planar
autoVMAT plan, for most patients, autoVMAT resulted in a
superior plan, with an average NTCP reduction of 4.0%.
(range: -25.4% to 0.5%, p = 0.013), a lower mean dose to
the healthy liver (p < 0.01) and lower doses to
gastrointestinal OARs (see figures). As significantly
suboptimal plans are easily identified, this approach is
well-suited for prospective feedback on treatment
planning for individual patients.
NTCP of the liver minus GTV for autoVMAT plans
(horizontal) and manual plans (vertical) for the same
patients.
Gastrointestinal OAR doses for autoVMAT plans and
manual plans.
Conclusion
Fully automated treatment planning has been
implemented in the QA program of the randomized
TRENDY trial for prospective plan QA (prior to plan
delivery), and contributes to the objective evaluation of
submitted treatment plans.
Proffered Papers: Patient safety and treatment
outcome
OC-0542 Dysphagia, Odynophagia and Globulus in
Patients Receiving RT for Spinal Cord Compression
V. Gram1, M. Hemer1, A. Appelt2, H. Pappot1, P. Sjøgren1,
L.S. Fog1
1Rigshospitalet, Department of Radiotherapy- Clinic of
Oncology, København, Denmark
2St James’s University Hospital, Leeds Institute of
Cancer and Pathology- University of Leeds and Leeds
Cancer Centre, Leeds, United Kingdom
Purpose or Objective
This study aimed at determining the incidence and
association of dysphagia with esophageal dose and disease
localization in patients receiving radiation therapy (RT)
for spinal cord compression (SCC).
Material and Methods
This prospective study included thirty consecutive
patients, who received 10 fractions of 3 Gy of RT for SCC
at our clinic. Patients were irradiated using VMAT with
daily CBCT. Patients were followed daily for 3 weeks,
using the mBPI and ESAS questionnaires and weekly using
the EORTC30 questionnaire; hereafter weekly using mBPI,
ESAS and EORTC30 for 4 weeks, totaling 7 weeks. Patients
were contacted by phone or personal interview. The
incidence of dysphagia, odynophagia and globulus
(collectively DOG) was determined. Since DOG typically