Dataset Information

Dummy Run of Quality Assurance Program before Prospective Study of Hippocampus-Sparing Whole-Brain Radiotherapy and Simultaneous Integrated Boost for Multiple Brain Metastases from Non-small Cell Lung Cancer: Korean Radiation Oncology Group (KROG) 17-06 Study.

ABSTRACT:

Purpose

Lung Cancer Subcommittee of Korean Radiation Oncology Group (KROG) has recently launched a prospective clinical trial (KROG 17-06) of hippocampus-sparing whole brain radiotherapy (HS-WBRT) with simultaneous integrated boost (SIB) in treating multiple brain metastases from non-small cell lung cancer. In order to improve trial quality, dummy run studies among the participating institutions were designed. This work reported the results of two-step dummy run procedures of the KROG 17-06 study.

Materials and methods

Two steps tested hippocampus contouring variability and radiation therapy planning compliance. In the first step, the variation of the hippocampus delineation was investigated for two representative cases using the Dice similarity coefficients. In the second step, the participating institutions were requested to generate a HS-WBRT with SIB treatment plan for another representative case. The compliance of the treatment plans to the planning protocol was evaluated.

Results

In the first step, the median Dice similarity coefficients of the hippocampus contours for two other dummy run cases changed from 0.669 (range, 0.073 to 0.712) to 0.690 (range, 0.522 to 0.750) and from 0.291 (range, 0.219 to 0.522) to 0.412 (range, 0.264 to 0.598) after providing the hippocampus contouring feedback. In the second step, with providing additional plan priority and extended dose constraints to the target volumes and normal structures, we observed the improved compliance of the treatment plans to the planning protocol.

Conclusion

The dummy run studies demonstrated the notable inter-institutional variability in delineating the hippocampus and treatment plan generation, which could be decreased through feedback from the trial center.

SUBMITTER: Chung E

PROVIDER: S-EPMC6639232 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Publications

Dummy Run of Quality Assurance Program before Prospective Study of Hippocampus-Sparing Whole-Brain Radiotherapy and Simultaneous Integrated Boost for Multiple Brain Metastases from Non-small Cell Lung Cancer: Korean Radiation Oncology Group (KROG) 17-06 Study.

Chung Eunah E Noh Jae Myoung JM Lee Kyu Chan KC Kim Jin Hee JH Chung Weon Kuu WK Suh Yang-Gun YG Lee Jung Ae JA Seol Ki Ho KH Wu Hong Gyun HG Kim Yeon Sil YS Noh O Kyu OK Park Jae Won JW Lee Dong Soo DS Lee Jihae J Kim Young Suk YS Park Woo-Yoon WY Kang Min Kyu MK Jo Sunmi S Ahn Yong Chan YC

Cancer research and treatment 20181015 3

<h4>Purpose</h4>Lung Cancer Subcommittee of Korean Radiation Oncology Group (KROG) has recently launched a prospective clinical trial (KROG 17-06) of hippocampus-sparing whole brain radiotherapy (HS-WBRT) with simultaneous integrated boost (SIB) in treating multiple brain metastases from non-small cell lung cancer. In order to improve trial quality, dummy run studies among the participating institutions were designed. This work reported the results of two-step dummy run procedures of the KROG 17 ...[more]

PMID: 30322229

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Project description:ObjectiveThis study aims to develop and validate SwinHS, a deep learning-based automatic segmentation model designed for precise hippocampus delineation in patients receiving hippocampus-protected whole-brain radiotherapy. By streamlining this process, we seek to significantly improve workflow efficiency for clinicians.MethodsA total of 100 three-dimensional T1-weighted MR images were collected, with 70 patients allocated for training and 30 for testing. Manual delineation of the hippocampus was performed according to RTOG0933 guidelines. The SwinHS model, which incorporates a 3D ELSA Transformer module and an sSE CNN decoder, was trained and tested on these datasets. To prove the effectiveness of SwinHS, this study compared the segmentation performance of SwinHS with that of V-Net, U-Net, ResNet and VIT. Evaluation metrics included the Dice similarity coefficient (DSC), Jaccard similarity coefficient (JSC), and Hausdorff distance (HD). Dosimetric evaluation compared radiotherapy plans generated using automatic segmentation (plan AD) versus manual hippocampus segmentation (plan MD).ResultsSwinHS outperformed four advanced deep learning-based models, achieving an average DSC of 0.894, a JSC of 0.817, and an HD of 3.430 mm. Dosimetric evaluation revealed that both plan (AD) and plan (MD) met treatment plan constraints for the target volume (PTV). However, the hippocampal Dmax in plan (AD) was significantly greater than that in plan (MD), approaching the 17 Gy constraint limit. Nonetheless, there were no significant differences in D100% or maximum doses to other critical structures between the two plans.ConclusionCompared with manual delineation, SwinHS demonstrated superior segmentation performance and a significantly shorter delineation time. While plan (AD) met clinical requirements, caution should be exercised regarding hippocampal Dmax. SwinHS offers a promising tool to enhance workflow efficiency and facilitate hippocampal protection in radiotherapy planning for patients with brain metastases.

Project description:BackgroundAdvanced radiotherapeutic treatment techniques limit the cognitive morbidity associated with whole-brain radiotherapy (WBRT) for brain metastasis through avoidance of hippocampal structures. However, achieving durable intracranial control remains challenging.MethodsWe conducted a single-institution single-arm phase II trial of hippocampal-sparing whole brain irradiation with simultaneous integrated boost (HSIB-WBRT) to metastatic deposits in adult patients with brain metastasis. Radiation therapy consisted of intensity-modulated radiation therapy delivering 20 Gy in 10 fractions over 2-2.5 weeks to the whole brain with a simultaneous integrated boost of 40 Gy in 10 fractions to metastatic lesions. Hippocampal regions were limited to 16 Gy. Cognitive performance and cancer outcomes were evaluated.ResultsA total of 50 patients, median age 60 years (interquartile range, 54-65), were enrolled. Median progression-free survival was 2.9 months (95% CI: 1.5-4.0) and overall survival was 9 months. As expected, poor survival and end-of-life considerations resulted in a high exclusion rate from cognitive testing. Nevertheless, mean decline in Hopkins Verbal Learning Test-Revised delayed recall (HVLT-R DR) at 3 months after HSIB-WBRT was only 10.6% (95% CI: -36.5‒15.3%). Cumulative incidence of local and intracranial failure with death as a competing risk was 8.8% (95% CI: 2.7‒19.6%) and 21.3% (95% CI: 10.7‒34.2%) at 1 year, respectively. Three grade 3 toxicities consisting of nausea, vomiting, and necrosis or headache were observed in 3 patients. Scores on the Multidimensional Fatigue Inventory 20 remained stable for evaluable patients at 3 months.ConclusionsHVLT-R DR after HSIB-WBRT was significantly improved compared with historical outcomes in patients treated with traditional WBRT, while achieving intracranial control similar to patients treated with WBRT plus stereotactic radiosurgery (SRS). This technique can be considered in select patients with multiple brain metastases who cannot otherwise receive SRS.

Dataset Information

Dummy Run of Quality Assurance Program before Prospective Study of Hippocampus-Sparing Whole-Brain Radiotherapy and Simultaneous Integrated Boost for Multiple Brain Metastases from Non-small Cell Lung Cancer: Korean Radiation Oncology Group (KROG) 17-06 Study.

Purpose

Materials and methods

Results

Conclusion

Publications

Dummy Run of Quality Assurance Program before Prospective Study of Hippocampus-Sparing Whole-Brain Radiotherapy and Simultaneous Integrated Boost for Multiple Brain Metastases from Non-small Cell Lung Cancer: Korean Radiation Oncology Group (KROG) 17-06 Study.

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