Wide-Scale Clinical Implementation of Knowledge-Based Planning: An Investigation of Workforce Efficiency, Need for Post-automation Refinement, and Data-Driven Model Maintenance.

Purpose: Our purpose was to investigate the effect of automated knowledge-based planning (KBP) on real-world clinical workflow efficiency, assess whether manual refinement of KBP plans improves plan quality across multiple disease sites, and develop a data-driven method to periodically improve KBP automated planning routines.

Methods And Materials: Using clinical knowledge-based automated planning routines for prostate, prostatic fossa, head and neck, and hypofractionated lung disease sites in a commercial KBP solution, workflow efficiency was compared in terms of planning time in a pre-KBP (n = 145 plans) and post-KBP (n = 503) patient cohort. Post-KBP, planning was initialized with KBP (KBP-only) and subsequently manually refined (KBP +human).

Radiation Recall Pneumonitis After Treatment With Checkpoint Blockade Immunotherapy: A Case Series and Review of Literature.

Background: Radiation recall pneumonitis (RRP) is a poorly understood clinical syndrome in which patients develop radiation pneumonitis triggered by a systemic agent, often years after the completion of radiation therapy. Immune checkpoint blockade agents have only recently been posited as a trigger for RRP. Here, we present three cases of immunotherapy-induced RRP.

Automated contouring and planning pipeline for hippocampal-avoidant whole-brain radiotherapy.

Background: Whole-brain radiotherapy (WBRT) remains an important treatment for over 200,000 cancer patients in the United States annually. Hippocampal-avoidant WBRT (HA-WBRT) reduces neurocognitive toxicity compared to standard WBRT, but HA-WBRT contouring and planning are more complex and time-consuming than standard WBRT. We designed and evaluated a workflow using commercially available artificial intelligence tools for automated hippocampal segmentation and treatment planning to efficiently generate clinically acceptable HA-WBRT radiotherapy plans.

Framework for Evaluation of Automated Knowledge-Based Planning Systems Using Multiple Publicly Available Prostate Routines.

Purpose: To establish a framework for the evaluation of knowledge-based planning routines that empowers new adopters to select systems that best match their clinical priorities. We demonstrate the power of this framework using 4 publicly available prostate routines.

Methods And Materials: Four publicly available prostate routines (CCMB, Miami, UCSD, WUSTL) were automatically applied across a 25-patient cohort using Eclipse scripting and a PTV prescription of V81 Gy = 95%.

Noninferiority Study of Automated Knowledge-Based Planning Versus Human-Driven Optimization Across Multiple Disease Sites.

Purpose: To evaluate whether automated knowledge-based planning (KBP) (a) is noninferior to human-driven planning across multiple disease sites and (b) systematically affects dosimetric plan quality and variability.

Methods And Materials: Clinical KBP automated planning routines were developed for prostate, prostatic fossa, hypofractionated lung, and head and neck. Clinical implementation consisted of independent generation of human-generated and KBP plans (145 cases across all sites), followed by blinded plan selection.

An in vitro study for the dosimetric and radiobiological validation of respiratory gating in conventional and hypofractionated radiotherapy of the lung: effect of dose, dose rate, and breathing pattern.

Stereotactic body radiotherapy (SBRT) of the lung has become a standard of care for early-stage inoperable non-small cell lung cancer (NSCLC). A common strategy to manage respiratory motion is gating, which inevitably results in an increase in treatment time, especially in irregularly-breathing patients. Flattening-filter free (FFF) beams allow for delivery of the treatment at a higher dose rate, therefore counteracting the lengthened treatment time due to frequent interruption of the beam during gated radiotherapy.

Automated Closed- and Open-Loop Validation of Knowledge-Based Planning Routines Across Multiple Disease Sites.

Purpose: Knowledge-based planning (KBP) clinical implementation necessitates significant upfront effort, even within a single disease site. The purpose of this study was to demonstrate an efficient method for clinicians to assess the noninferiority of KBP across multiple disease sites and estimate any systematic dosimetric differences after implementation. We sought to establish these endpoints in a plurality of previously treated patients (validation set) with both closed-loop (training set overlapping validation set) and open-loop (independent training set) KBP routines.

A novel 3D-printed phantom insert for 4D PET/CT imaging and simultaneous integrated boost radiotherapy.

Purpose: To construct a 3D-printed phantom insert designed to mimic the variable PET tracer uptake seen in lung tumor volumes and a matching dosimetric insert to be used in simultaneous integrated boost (SIB) phantom studies, and to evaluate the design through end-to-end tests.

Methods: A set of phantom inserts was designed and manufactured for a realistic representation of gated radiotherapy steps from 4D PET/CT scanning to dose delivery. A cylindrical phantom (φ80 × 120 mm) holds inserts for PET/CT scanning.

Prospective study of functional bone marrow-sparing intensity modulated radiation therapy with concurrent chemotherapy for pelvic malignancies.

Purpose: To test the hypothesis that intensity modulated radiation therapy (IMRT) can reduce radiation dose to functional bone marrow (BM) in patients with pelvic malignancies (phase IA) and estimate the clinical feasibility and acute toxicity associated with this technique (phase IB).

Methods And Materials: We enrolled 31 subjects (19 with gynecologic cancer and 12 with anal cancer) in an institutional review board-approved prospective trial (6 in the pilot study, 10 in phase IA, and 15 in phase IB). The mean age was 52 years; 8 of 31 patients (26%) were men.

Patterns of imaging failures in glioblastoma patients treated with chemoradiation: a retrospective study.

Glioblastoma multiforme (GBM) is the most common primary brain tumor of adults and carries a poor prognosis. This study sought to investigate recurrence patterns of GBM treated with temozolomide-based chemoradiation. Records for 31 patients treated for newly diagnosed GBM between 2007 and 2009 were retrospectively analyzed.