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Automating the Treatment Planning Process for 3D-Conformal Pediatric Craniospinal Irradiation Therapy
  • +13
  • Soleil Hernandez,
  • Callistus Nguyen,
  • Jeannette Parkes,
  • Hester Burger,
  • Dong Joo Rhee,
  • Tucker Netherton,
  • Raymond Mumme,
  • Jean Gumma-De La Vega,
  • Jack Duryea,
  • Alexandra Leone,
  • Arnold Paulino,
  • Carlos Cardenas,
  • Rebecca M. Howell,
  • David Fuentes,
  • Julianne Pollard-Larkin,
  • Laurence Court
Soleil Hernandez
The University of Texas Graduate School of Biomedical Sciences

Corresponding Author:[email protected]

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Callistus Nguyen
The University of Texas MD Anderson Cancer Center Department of Radiation Physics
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Jeannette Parkes
University of Cape Town Department of Radiation Medicine
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Hester Burger
Department Medical Physics Groote Schuur Hospital and University of Cape Town Cape Town South Africa
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Dong Joo Rhee
The University of Texas MD Anderson Cancer Center Department of Radiation Physics
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Tucker Netherton
The University of Texas Graduate School of Biomedical Sciences
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Raymond Mumme
The University of Texas MD Anderson Cancer Center Department of Radiation Physics
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Jean Gumma-De La Vega
The University of Texas MD Anderson Cancer Center Department of Radiation Physics
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Jack Duryea
The University of Texas MD Anderson Cancer Center Department of Radiation Physics
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Alexandra Leone
The University of Texas MD Anderson Cancer Center Department of Radiation Physics
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Arnold Paulino
The University of Texas MD Anderson Cancer Center Division of Radiation Oncology
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Carlos Cardenas
The University of Alabama at Birmingham Department of Radiation Oncology
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Rebecca M. Howell
The University of Texas Graduate School of Biomedical Sciences
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David Fuentes
The University of Texas Graduate School of Biomedical Sciences
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Julianne Pollard-Larkin
The University of Texas Graduate School of Biomedical Sciences
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Laurence Court
The University of Texas Graduate School of Biomedical Sciences
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Abstract

Purpose: Pediatric patients with medulloblastoma in LMICs are most treated with 3D conformal photon craniospinal irradiation (CSI), a time-consuming, complex treatment to plan, especially in resource-constrained settings. Therefore, we developed and tested a 3D conformal CSI autoplanning tool for varying patient lengths. Methods and Materials: Autocontours were generated with a deep learning model trained:tested (80:20 ratio) on 143 pediatric medulloblastoma CT scans (patient ages, 2-19 years, median=7 years). Using the verified autocontours, the autoplanning tool generated 2 lateral brain fields matched to a single spine field, an extended single spine field, or 2 matched spine fields. Additional spine sub-fields were added to optimize the corresponding dose distribution. Feathering was implemented (yielding 9-12 fields) to give a composite plan. Each planning approach was tested on 6 patients (ages, 3-10 years). A pediatric radiation oncologist assessed clinical acceptability of each autoplan. Results: The autocontoured structures’ average Dice similarity coefficient ranged from 0.65-0.98. The average V95 for the brain/spinal canal for single, extended, and multi-field spine configurations was 99.9±0.06%/99.9±0.10%, 99.9±0.07%/99.4±0.30%, and 99.9±0.06%/99.4±0.40%, respectively. The average maximum dose across all field configurations to the brainstem, eyes (L/R), lenses (L/R) and spinal cord were 23.7±0.08 Gy, 24.1±0.28 Gy, 13.3±5.27 Gy, 25.5±0.34 Gy, respectively (prescription=23.4 Gy/13 fractions). Of the 18 plans tested, all were scored as clinically acceptable as-is or clinically acceptable with minor, time-efficient edits preferred or required. No plans were scored as clinically unacceptable. Conclusion: The autoplanning tool successfully generated pediatric CSI plans for varying patient lengths in 3.50 ± 0.4 minutes on average, indicating potential for an efficient planning aid in resource-constrained settings.
12 Aug 2022Assigned to Editor
12 Aug 2022Submitted to Pediatric Blood & Cancer
12 Aug 2022Submission Checks Completed
17 Aug 2022Reviewer(s) Assigned
29 Sep 2022Review(s) Completed, Editorial Evaluation Pending
03 Oct 2022Editorial Decision: Revise Major
11 Oct 2022Assigned to Editor
11 Oct 20221st Revision Received
11 Oct 2022Submission Checks Completed
11 Oct 2022Reviewer(s) Assigned
17 Nov 2022Review(s) Completed, Editorial Evaluation Pending
21 Nov 2022Editorial Decision: Revise Minor
22 Nov 2022Submission Checks Completed
22 Nov 2022Assigned to Editor
22 Nov 20222nd Revision Received
24 Nov 2022Review(s) Completed, Editorial Evaluation Pending
28 Nov 2022Editorial Decision: Accept
Mar 2023Published in Pediatric Blood & Cancer volume 70 issue 3. 10.1002/pbc.30164