Plan quality assessment in clinical practice: Results of the 2020 ESTRO survey on plan complexity and robustness

Identifier:  imarina:9334302

Handle: https://hdl.handle.net/20.500.11797/imarina9334302

Authors:  Kaplan, Laura Patricia; Placidi, Lorenzo; Back, Anna; Canters, Richard; Hussein, Mohammad; Vaniqui, Ana; Fusella, Marco; Piotrowski, Tomasz; Hernandez, Victor; Jornet, Nuria; Hansen, Christian Ronn; Widesott, Lamberto

Abstract:
Purpose: Plan complexity and robustness are two essential aspects of treatment plan quality but there is a great variability in their management in clinical practice. This study reports the results of the 2020 ESTRO survey on plan complexity and robustness to identify needs and guide future discussions and con-sensus.Methods: A survey was distributed online to ESTRO members. Plan complexity was defined as the mod-ulation of machine parameters and increased uncertainty in dose calculation and delivery. Robustness was defined as a dose distribution's sensitivity towards errors stemming from treatment uncertainties, patient setup, or anatomical changes.Results: A total of 126 radiotherapy centres from 33 countries participated, 95 of them (75%) from Europe and Central Asia. The majority controlled and evaluated plan complexity using monitor units (56 centres) and aperture shapes (38 centres). To control robustness, 98 (97% of question responses) photon and 5 (50%) proton centres used PTV margins for plan optimization while 75 (94%) and 5 (50%), respectively, used margins for plan evaluation. Seventeen (21%) photon and 8 (80%) proton centres used robust opti-misation, while 10 (13%) and 8 (80%), respectively, used robust evaluation. Primary uncertainties consid-ered were patient setup (photons and protons) and range calculation uncertainties (protons). Participants expressed the need for improved commercial tools to control and evaluate plan complexity and robust-ness.Conclusion: Clinical implementation of methods to control and evaluate plan complexity and robustness is very heterogeneous. Better tools are needed to manage complexity and robustness in treatment plan-ning systems. International guidelines may promote harmonization.(c) 2022 The Authors. Published by Elsevier B.V. Radiotherapy and Oncology 173 (2022) 254-261 This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).