The TRENDY multi-center randomized trial on hepatocellular carcinoma – Trial QA including automated treatment planning and benchmark-case results

Steven J.M. Habraken, Abdul Wahab M. Sharfo, Jeroen Buijsen, Wilko F.A.R. Verbakel, Cornelis J.A. Haasbeek, Michel C. Öllers, Henrike Westerveld, Niek van Wieringen, Onne Reerink, Enrica Seravalli, Pètra M. Braam, Markus Wendling, Thomas Lacornerie, Xavier Mirabel, Reinhilde Weytjens, Lieselotte Depuydt, Stephanie Tanadini-Lang, Oliver Riesterer, Karin Haustermans, Tom Depuydt & 4 others Roy S. Dwarkasing, François E.J.A. Willemssen, Ben J.M. Heijmen, Alejandra Méndez Romero

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background and purpose The TRENDY trial is an international multi-center phase-II study, randomizing hepatocellular carcinoma (HCC) patients between transarterial chemoembolization (TACE) and stereotactic body radiation therapy (SBRT) with a target dose of 48–54 Gy in six fractions. The radiotherapy quality assurance (QA) program, including prospective plan feedback based on automated treatment planning, is described and results are reported. Materials and methods Scans of a single patient were used as a benchmark case. Contours submitted by nine participating centers were compared with reference contours. The subsequent planning round was based on a single set of contours. A total of 20 plans from participating centers, including 12 from the benchmark case, 5 from a clinical pilot and 3 from the first study patients, were compared to automatically generated VMAT plans. Results For the submitted liver contours, Dice Similarity Coefficients (DSC) with the reference delineation ranged from 0.925 to 0.954. For the GTV, the DSC varied between 0.721 and 0.876. For the 12 plans on the benchmark case, healthy liver normal-tissue complication probabilities (NTCPs) ranged from 0.2% to 22.2% with little correlation between NCTP and PTV-D95% (R2 < 0.3). Four protocol deviations were detected in the set of 20 treatment plans. Comparison with co-planar autoVMAT QA plans revealed these were due to too high target dose and suboptimal planning. Overall, autoVMAT resulted in an average liver NTCP reduction of 2.2 percent point (range: 16.2 percent point to −1.8 percent point, p = 0.03), and lower doses to the healthy liver (p < 0.01) and gastrointestinal organs at risk (p < 0.001). Conclusions Delineation variation resulted in feedback to participating centers. Automated treatment planning can play an important role in clinical trials for prospective plan QA as suboptimal plans were detected.

Original languageEnglish
Pages (from-to)507-513
Number of pages7
JournalRadiotherapy and Oncology
Volume125
Issue number3
DOIs
Publication statusPublished - 1 Dec 2017

Cite this

Habraken, Steven J.M. ; Sharfo, Abdul Wahab M. ; Buijsen, Jeroen ; Verbakel, Wilko F.A.R. ; Haasbeek, Cornelis J.A. ; Öllers, Michel C. ; Westerveld, Henrike ; van Wieringen, Niek ; Reerink, Onne ; Seravalli, Enrica ; Braam, Pètra M. ; Wendling, Markus ; Lacornerie, Thomas ; Mirabel, Xavier ; Weytjens, Reinhilde ; Depuydt, Lieselotte ; Tanadini-Lang, Stephanie ; Riesterer, Oliver ; Haustermans, Karin ; Depuydt, Tom ; Dwarkasing, Roy S. ; Willemssen, François E.J.A. ; Heijmen, Ben J.M. ; Méndez Romero, Alejandra. / The TRENDY multi-center randomized trial on hepatocellular carcinoma – Trial QA including automated treatment planning and benchmark-case results. In: Radiotherapy and Oncology. 2017 ; Vol. 125, No. 3. pp. 507-513.
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abstract = "Background and purpose The TRENDY trial is an international multi-center phase-II study, randomizing hepatocellular carcinoma (HCC) patients between transarterial chemoembolization (TACE) and stereotactic body radiation therapy (SBRT) with a target dose of 48–54 Gy in six fractions. The radiotherapy quality assurance (QA) program, including prospective plan feedback based on automated treatment planning, is described and results are reported. Materials and methods Scans of a single patient were used as a benchmark case. Contours submitted by nine participating centers were compared with reference contours. The subsequent planning round was based on a single set of contours. A total of 20 plans from participating centers, including 12 from the benchmark case, 5 from a clinical pilot and 3 from the first study patients, were compared to automatically generated VMAT plans. Results For the submitted liver contours, Dice Similarity Coefficients (DSC) with the reference delineation ranged from 0.925 to 0.954. For the GTV, the DSC varied between 0.721 and 0.876. For the 12 plans on the benchmark case, healthy liver normal-tissue complication probabilities (NTCPs) ranged from 0.2{\%} to 22.2{\%} with little correlation between NCTP and PTV-D95{\%} (R2 < 0.3). Four protocol deviations were detected in the set of 20 treatment plans. Comparison with co-planar autoVMAT QA plans revealed these were due to too high target dose and suboptimal planning. Overall, autoVMAT resulted in an average liver NTCP reduction of 2.2 percent point (range: 16.2 percent point to −1.8 percent point, p = 0.03), and lower doses to the healthy liver (p < 0.01) and gastrointestinal organs at risk (p < 0.001). Conclusions Delineation variation resulted in feedback to participating centers. Automated treatment planning can play an important role in clinical trials for prospective plan QA as suboptimal plans were detected.",
keywords = "Automated treatment planning for plan QA, Benchmark-case delineation, Benchmark-case treatment planning, QA in clinical trials",
author = "Habraken, {Steven J.M.} and Sharfo, {Abdul Wahab M.} and Jeroen Buijsen and Verbakel, {Wilko F.A.R.} and Haasbeek, {Cornelis J.A.} and {\"O}llers, {Michel C.} and Henrike Westerveld and {van Wieringen}, Niek and Onne Reerink and Enrica Seravalli and Braam, {P{\`e}tra M.} and Markus Wendling and Thomas Lacornerie and Xavier Mirabel and Reinhilde Weytjens and Lieselotte Depuydt and Stephanie Tanadini-Lang and Oliver Riesterer and Karin Haustermans and Tom Depuydt and Dwarkasing, {Roy S.} and Willemssen, {Fran{\cc}ois E.J.A.} and Heijmen, {Ben J.M.} and {M{\'e}ndez Romero}, Alejandra",
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Habraken, SJM, Sharfo, AWM, Buijsen, J, Verbakel, WFAR, Haasbeek, CJA, Öllers, MC, Westerveld, H, van Wieringen, N, Reerink, O, Seravalli, E, Braam, PM, Wendling, M, Lacornerie, T, Mirabel, X, Weytjens, R, Depuydt, L, Tanadini-Lang, S, Riesterer, O, Haustermans, K, Depuydt, T, Dwarkasing, RS, Willemssen, FEJA, Heijmen, BJM & Méndez Romero, A 2017, 'The TRENDY multi-center randomized trial on hepatocellular carcinoma – Trial QA including automated treatment planning and benchmark-case results' Radiotherapy and Oncology, vol. 125, no. 3, pp. 507-513. https://doi.org/10.1016/j.radonc.2017.09.007

The TRENDY multi-center randomized trial on hepatocellular carcinoma – Trial QA including automated treatment planning and benchmark-case results. / Habraken, Steven J.M.; Sharfo, Abdul Wahab M.; Buijsen, Jeroen; Verbakel, Wilko F.A.R.; Haasbeek, Cornelis J.A.; Öllers, Michel C.; Westerveld, Henrike; van Wieringen, Niek; Reerink, Onne; Seravalli, Enrica; Braam, Pètra M.; Wendling, Markus; Lacornerie, Thomas; Mirabel, Xavier; Weytjens, Reinhilde; Depuydt, Lieselotte; Tanadini-Lang, Stephanie; Riesterer, Oliver; Haustermans, Karin; Depuydt, Tom; Dwarkasing, Roy S.; Willemssen, François E.J.A.; Heijmen, Ben J.M.; Méndez Romero, Alejandra.

In: Radiotherapy and Oncology, Vol. 125, No. 3, 01.12.2017, p. 507-513.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - The TRENDY multi-center randomized trial on hepatocellular carcinoma – Trial QA including automated treatment planning and benchmark-case results

AU - Habraken, Steven J.M.

AU - Sharfo, Abdul Wahab M.

AU - Buijsen, Jeroen

AU - Verbakel, Wilko F.A.R.

AU - Haasbeek, Cornelis J.A.

AU - Öllers, Michel C.

AU - Westerveld, Henrike

AU - van Wieringen, Niek

AU - Reerink, Onne

AU - Seravalli, Enrica

AU - Braam, Pètra M.

AU - Wendling, Markus

AU - Lacornerie, Thomas

AU - Mirabel, Xavier

AU - Weytjens, Reinhilde

AU - Depuydt, Lieselotte

AU - Tanadini-Lang, Stephanie

AU - Riesterer, Oliver

AU - Haustermans, Karin

AU - Depuydt, Tom

AU - Dwarkasing, Roy S.

AU - Willemssen, François E.J.A.

AU - Heijmen, Ben J.M.

AU - Méndez Romero, Alejandra

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background and purpose The TRENDY trial is an international multi-center phase-II study, randomizing hepatocellular carcinoma (HCC) patients between transarterial chemoembolization (TACE) and stereotactic body radiation therapy (SBRT) with a target dose of 48–54 Gy in six fractions. The radiotherapy quality assurance (QA) program, including prospective plan feedback based on automated treatment planning, is described and results are reported. Materials and methods Scans of a single patient were used as a benchmark case. Contours submitted by nine participating centers were compared with reference contours. The subsequent planning round was based on a single set of contours. A total of 20 plans from participating centers, including 12 from the benchmark case, 5 from a clinical pilot and 3 from the first study patients, were compared to automatically generated VMAT plans. Results For the submitted liver contours, Dice Similarity Coefficients (DSC) with the reference delineation ranged from 0.925 to 0.954. For the GTV, the DSC varied between 0.721 and 0.876. For the 12 plans on the benchmark case, healthy liver normal-tissue complication probabilities (NTCPs) ranged from 0.2% to 22.2% with little correlation between NCTP and PTV-D95% (R2 < 0.3). Four protocol deviations were detected in the set of 20 treatment plans. Comparison with co-planar autoVMAT QA plans revealed these were due to too high target dose and suboptimal planning. Overall, autoVMAT resulted in an average liver NTCP reduction of 2.2 percent point (range: 16.2 percent point to −1.8 percent point, p = 0.03), and lower doses to the healthy liver (p < 0.01) and gastrointestinal organs at risk (p < 0.001). Conclusions Delineation variation resulted in feedback to participating centers. Automated treatment planning can play an important role in clinical trials for prospective plan QA as suboptimal plans were detected.

AB - Background and purpose The TRENDY trial is an international multi-center phase-II study, randomizing hepatocellular carcinoma (HCC) patients between transarterial chemoembolization (TACE) and stereotactic body radiation therapy (SBRT) with a target dose of 48–54 Gy in six fractions. The radiotherapy quality assurance (QA) program, including prospective plan feedback based on automated treatment planning, is described and results are reported. Materials and methods Scans of a single patient were used as a benchmark case. Contours submitted by nine participating centers were compared with reference contours. The subsequent planning round was based on a single set of contours. A total of 20 plans from participating centers, including 12 from the benchmark case, 5 from a clinical pilot and 3 from the first study patients, were compared to automatically generated VMAT plans. Results For the submitted liver contours, Dice Similarity Coefficients (DSC) with the reference delineation ranged from 0.925 to 0.954. For the GTV, the DSC varied between 0.721 and 0.876. For the 12 plans on the benchmark case, healthy liver normal-tissue complication probabilities (NTCPs) ranged from 0.2% to 22.2% with little correlation between NCTP and PTV-D95% (R2 < 0.3). Four protocol deviations were detected in the set of 20 treatment plans. Comparison with co-planar autoVMAT QA plans revealed these were due to too high target dose and suboptimal planning. Overall, autoVMAT resulted in an average liver NTCP reduction of 2.2 percent point (range: 16.2 percent point to −1.8 percent point, p = 0.03), and lower doses to the healthy liver (p < 0.01) and gastrointestinal organs at risk (p < 0.001). Conclusions Delineation variation resulted in feedback to participating centers. Automated treatment planning can play an important role in clinical trials for prospective plan QA as suboptimal plans were detected.

KW - Automated treatment planning for plan QA

KW - Benchmark-case delineation

KW - Benchmark-case treatment planning

KW - QA in clinical trials

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U2 - 10.1016/j.radonc.2017.09.007

DO - 10.1016/j.radonc.2017.09.007

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EP - 513

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JF - Radiotherapy and Oncology

SN - 0167-8140

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