Clinical utility of automatic treatment planning for proton therapy of head-and-neck cancer patients using JulianA

TL;DR

This study evaluates JulianA, an automatic treatment planning system for proton therapy in head-and-neck cancer, demonstrating its potential to produce clinically acceptable, often superior plans compared to manual planning, with implications for efficiency and quality assurance.

Contribution

The paper introduces JulianA, an automatic treatment planning tool that outperforms manual plans in acceptability and conformity, showing readiness for clinical use in proton therapy.

Findings

JulianA plans were acceptable in all cases.

JulianA was preferred in 82.4% of cases.

JulianA produced more conformal dose distributions.

Abstract

Background: Automatic treatment planning promises many benefits for both research and clinical environments. For clinics, autoplanning promises to reduce planning time and achieve more comparable treatment plans and thereby reduce inter-planner variability. Further, it can assist clinicians in quality assurance by providing a minimum plan quality standard. Finally, autoplanning is an essential part of patient selection, which is crucial for the advancement of proton therapy itself. Methods: A retrospective planning study using a cohort of 17 head-and-neck cancer patients treated at our institute. The clinically accepted plans created by dosimetrists (d-plans) were compared to automatically generated JulianA plans (j-plans). Both methods used the same beam arrangement. The plans were analysed by two expert reviewers without knowing how each plan was created. They assessed the plan quality and stated a preference. Results: All of the j-plans were deemed rather or clearly acceptable, resulting in a higher acceptability than the d-plans. The j-plan was considered superior in 14 (82.4%) cases, of equal quality for 1 (5.9%) and inferior to the d-plan for only 2 (11.8%) of the cases. The reviewers concluded that JulianA achieves more conformal dose distributions for the 15 (88.2%) cases where the j-plans were at least as good as the d-plans. Conclusions: The results show that the JulianA is ready to be used as a clinical quality assurance tool and research platform at our institute. While these results are encouraging, further research is needed to reduce the number of spots further and introduce robustness considerations into the optimisation algorithm in order to employ it on a daily basis for patient treatment.