Comprehensive Comparison of Progressive Optimization Algorithm Based Automatic Plan and Manually Planned Treatment Technique for Cervical-Thoracic Esophageal Cancers

PURPOSE: The purpose of the present study was first to apply the progressive optimization algorithm based automatic volumetric modulated arc therapy (POA-VMAT) technology to accelerate and improve the radiotherapy of cervicothoracic esophageal cancer (CTEC). We comprehensive analyze the feasibility, normal tissue complication probability (NTCP) and dosimetric results of POA-VMAT, manual based VMAT and step-shoot intensity-modulated radiation therapy (IMRT) plans in the treatment of CTEC. METHODS: Sixty patients with CTEC with or without concomitant chemotherapy at our institution between 2017 and 2019 were retrospectively identified. The manual 7field-IMRT (7f-IMRT), Single-arc-VMAT and Double-arc-VMAT (Single-Arc/Double-Arc) plans were generated in all cases. The POA-VMAT was designed using the automatic dual-arc VMAT technology of Pinnacle(3) 9.10 planning system based on progressive optimization algorithm. Specially, it includes the selection of treatment techniques, the running of automated planning scripts, and the evaluation of the final radiotherapy regimen. Subsequently, quantitative evaluation of plans was performed by means of standard dose–volume histograms, homogeneity index (HI) and conformity index (CI). RESULTS: Target dose conformity of the 7f-IMRT plan was inferior to all plans, whereas the Double-Arc plan was slightly inferior to the POA-VMAT but superior to the Single-Arc and 7f-IMRT plan. The HI for 7f-IMRT, Single-Arc, Double-Arc and POA-VMAT were 0.17 ± 0.08, 0.28 ± 0.06, 0.29 ± 0.06 and 0.28 ± 0.03, respectively. For the NTCP results, there was significant statistical difference among POA-VMAT, IMRT and VMAT plans. The total MU was reduced by 48.3% and 42.1% in Single-Arc and POA-VMAT plans compare to IMRT plans. CONCLUSIONS: By comprehensive consideration, POA-VMAT efficiently generate acceptable treatment plans for CTEC without dose escalation to OARs and overall superior to manual planning which is a good option for treating CTEC.