Are offline ART decisions for NSCLC impacted by the type of dose calculation algorithm?

Dylan Callens; Karel Aerts; Patrick Berkovic; Liesbeth Vandewinckele; Maarten Lambrecht; Wouter Crijns

doi:10.1016/j.tipsro.2024.100236

Are offline ART decisions for NSCLC impacted by the type of dose calculation algorithm?

Tech Innov Patient Support Radiat Oncol. 2024 Jan 12:29:100236. doi: 10.1016/j.tipsro.2024.100236. eCollection 2024 Mar.

Authors

Dylan Callens^{1

2}, Karel Aerts¹, Patrick Berkovic^{1

2}, Liesbeth Vandewinckele^{1

2}, Maarten Lambrecht^{1

2}, Wouter Crijns^{1

2}

Affiliations

¹ Laboratory of Experimental Radiotherapy, KU Leuven, Leuven, Belgium.
² Department of Radiation Oncology, UZ Leuven, Leuven, Belgium.

Abstract

Introduction: Decisions for plan-adaptations may be impacted by a transitioning from one dose-calculation algorithm to another. This study examines the impact on dosimetric-triggered offline adaptation in LA-NSCLC in the context of a transition from superposition/convolution dose calculation algorithm (Type-B) to linear Boltzmann equation solver dose calculation algorithms (Type-C).

Materials & methods: Two dosimetric-triggered offline adaptive treatment workflows are compared in a retrospective planning study on 30 LA-NSCLC patients. One workflow uses a Type-B dose calculation algorithm and the other uses Type-C. Treatment plans were re-calculated on the anatomy of a mid-treatment synthetic-CT utilizing the same algorithm utilized for pre-treatment planning. Assessment for plan-adaptation was evaluated through a decision model based on target coverage and OAR constraint violation. The impact of algorithm during treatment planning was controlled for by recalculating the Type-B plan with Type-C.

Results: In the Type-B approach, 13 patients required adaptation due to OAR-constraint violations, while 15 patients required adaptation in the Type-C approach. For 8 out of 30 cases, the decision to adapt was opposite in both approaches. None of the patients in our dataset encountered CTV-target underdosage that necessitated plan-adaptation. Upon recalculating the Type-B approach with the Type-C algorithm, it was shown that 10 of the original Type-B plans revealed clinically relevant dose reductions (≥3%) on the CTV in their original plans. This re-calculation identified 21 plans in total that required ART.

Discussion: In our study, nearly one-third of the cases would have a different decision for plan-adaption when utilizing Type-C instead of Type-B. There was no substantial increase in the total number of plan-adaptations for LA-NSCLC. However, Type-C is more sensitive to altered anatomy during treatment compared to Type-B. Recalculating Type-B plans with the Type-C algorithm revealed an increase from 13 to 21 cases triggering ART.

Keywords: Adaptive radiotherapy; Dose calculation; NSCLC.