Implementation of Machine Learning Models to Ensure Radiotherapy Quality for Multicenter Clinical Trials: Report from a Phase III Lung Cancer Study

SIMPLE SUMMARY: Over 50% of all cancer patients receive radiation therapy (RT). The quality of the RT treatment plan is directly related to patient outcomes, such as overall survival and complications related to RT. In this study, we explore a knowledge-based machine learning tool for RT plan quality evaluation on plans submitted to a multicenter non-small-cell lung cancer clinical trial. The results of this study may provide critical information for the analysis of the end points of the trial. This study also demonstrated the feasibility of using this novel tool for RT plan quality assessment in the multicenter clinical trial setting. ABSTRACT: The outcome of the patient and the success of clinical trials involving RT is dependent on the quality assurance of the RT plans. Knowledge-based Planning (KBP) models using data from a library of high-quality plans have been utilized in radiotherapy to guide treatment. In this study, we report on the use of these machine learning tools to guide the quality assurance of multicenter clinical trial plans. The data from 130 patients submitted to RTOG1308 were included in this study. Fifty patient cases were used to train separate photon and proton models on a commercially available platform based on principal component analysis. Models evaluated 80 patient cases. Statistical comparisons were made between the KBP plans and the original plans submitted for quality evaluation. Both photon and proton KBP plans demonstrate a statistically significant improvement of quality in terms of organ-at-risk (OAR) sparing. Proton KBP plans, a relatively emerging technique, show more improvements compared with photon plans. The KBP proton model is a useful tool for creating proton plans that adhere to protocol requirements. The KBP tool was also shown to be a useful tool for evaluating the quality of RT plans in the multicenter clinical trial setting.