Şeyda KINAY, Doğukan AKÇAY, Cenk UMAY, Barbaros AYDIN, Dilara GÜLŞAN, Kadir AKGÜNGÖR, Ayşe Nur DEMİRAL

PROSTAT KANSERİNİN HACİMSEL MODÜLASYONLU ARK TEDAVİSİ İLE RADYOTERAPİSİNDE BİLGİ TABANLI PLANLAMA YÖNTEMLERİNİN KULLANILDIĞI KLİNİK ÇALIŞMALARIN DEĞERLENDİRİLMESİ

Bilgi Tabanlı Planlama (“Knowledge Based Planningˮ-KBP), klinik olarak kabul edilebilir Yoğunluk Ayarlı Radyoterapi (“Intensity Modulated Radiotherapy”-IMRT) ve Hacimsel Modülasyonlu Ark Tedavisi (“Volumetric Modulated Arc Therapy”-VMAT) planlarını minimum iş akışıyla optimize etmek için bilgi tabanlı modeller (“Knowledge Based Model”–KBM) kullanarak plan kalitesini standart hale getirmeyi amaçlar. KBP, Risk Altındaki Organlar (‟Organ at Risk”-OAR) için ulaşılabilir Doz-Volüm Histogramı (DVH)’nı tahmin eder ve her bir yeni hasta için ideal optimizasyon hedefleri sağlar. KBP modeli, plan kalitesini iyileştirir, plan tutarlılığını koruyarak planlayıcılar arası değişkenliği azaltır ve simülasyondan tedavi başlangıcına dek geçen süreyi kısaltır. Bu derlemede prostat kanserinin VMAT tekniği ile tedavisinde KBP tabanlı yöntemlerin kullanıldığı klinik çalışmaların sonuçları incelendi. “Knowledge-based treatment planning”, “prostate cancer”, “VMAT” anahtar kelimeleri kullanılarak “PubMed” tarama motorunda “Clinical Trial” kategorisindeki İngilizce olarak yayınlanmış makalelerin taranması sonucu ulaşılan beş adet çalışma derleme kapsamına alındı. Bu klinik çalışmaların tümünde temelde KBP modelinin dozimetrik ve mekanik performansını değerlendirmek ve optimize etmek istenmiştir. Bu nedenle her bir kliniğin deneyimine göre hazırlanan manuel planlar, KBP ile oluşturulan otomatik planlar ile karşılaştırılmıştır. Prostat kanserinin VMAT planlamasında KBP kullanımı, doğrulama çalışmalarında, güçlü bir şekilde performans göstermiştir. KBP yöntemleri, plan kalitesi açısından genellikle uzman seviyesindeki planlayıcılara eşdeğerdir ancak ön sonuçlar, önemli ölçüde daha gelişmiş olduklarını göstermektedir. Hedef volüm ile örtüşen OAR volümlerinin dikkate alındığı KBP modellerinin örtüşme volüm histogramı (“overlap volüme histogram”-OVH) rehberliğinde daha hassas ve doğru doz tahminleri yapabileceği düşünülmektedir. KBP yöntemlerinin uygulaması sırasında dozimetrik ve mekanik performansın yanı sıra hastaya özgü kalite güvenirliğini (“Quality Assurance” –QA) doğrulamak da çok önemlidir.

Anahtar Kelimeler:

BİLGİ TABANLI PLANLAMA, HACİMSEL MODÜLASYONLU ARK TEDAVİSİ, PROSTAT KANSERİ

EVALUATION OF CLINICAL STUDIES USING KNOWLEDGE BASED PLANNING METHODS IN THE RADIOTHERAPY OF PROSTATE CANCER WITH VOLUMETRIC MODULATED ARC THERAPY

Knowledge-Based Planning (KBP) aims standardizing plan quality using models (Knowledge-Based Model (KBM)) to optimize clinically acceptable Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) plans with minimum workflow. KBP predicts the achievable Dose-Volume Histogram (DVH) for Organ at Risk (OAR) and provides ideal optimization targets for each new patient. The KBP model improves plan quality, maintains plan consistency through reducing inter-planner variability, and shortens the time from simulation to treatment initiation. In this review, we assessed the results of clinical trials using the KBP-based methods in the treatment of prostate cancer with the VMAT technique. Five studies, which were reached using the keywords “knowledge-based treatment planning”, “prostate cancer”, and “VMAT” and published in English in the category of “Clinical Trial” in the “PubMed” search engine, were included in the review. All of these clinical trials aimed to evaluate the dosimetric and mechanical performance of the KBP model and to optimize it. For this reason, manual plans prepared according to the experience of each clinic were compared with automatic plans created by KBP. The use of KBP in VMAT planning of prostate cancer has shown strong performance in validation studies. KBP methods are generally equivalent to expert-level planners in terms of plan quality, however preliminary results show that they are significantly more advanced. It is considered that KBP models which take into account OAR volumes overlapping with target volume are able to make more sensitive and accurate dose estimations under the guidance of the Overlap Volume Histogram (OVH). It is very important to verify patient-specific Quality Assurance (QA) as well as dosimetric and mechanical performance in KBP methods.

Keywords:

Knowledge Based Planning, Volumetric Arc Therapy, PROSTATE CANCER,

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