Purpose: Bi-objective treatment planning for high-dose-rate prostate brachytherapy is a novel treatment planning method with two separate objectives that represent target coverage and organ-at-risk sparing. In this study, we investigated the feasibility and plan quality of this method by means of a retrospective observer study.

Methods and Materials: Current planning sessions were recorded to configure a bi-objective optimization model and to assess its applicability to our clinical practice. Optimization software, GOMEA, was then used to automatically generate a large set of plans with different trade-offs in the two objectives for each of 18 patients treated with high-dose-rate prostate brachytherapy. From this set, five plans per patient were selected for comparison to the clinical plan in terms of satisfaction of planning criteria and in a retrospective observer study. Three brachytherapists were asked to evaluate the blinded plans and select the preferred one.

Results: Recordings demonstrated applicability of the bi-objective optimization model to our clinical practice. For 14/18 patients, GOMEA plans satisfied all planning criteria, compared with 4/18 clinical plans. In the observer study, in 53/54 cases, a GOMEA plan was preferred over the clinical plan. When asked for consensus among observers, this ratio was 17/18 patients. Observers highly appreciated the insight gained from comparing multiple plans with different trade-offs simultaneously.

Conclusions: The bi-objective optimization model adapted well to our clinical practice. GOMEA plans were considered equal or superior to the clinical plans. In addition, presenting multiple high-quality plans provided novel insight into patient-specific trade-offs.

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ICT based Innovations in the Battle against Cancer – Next - Generation Patient -Tailored Brachytherapy Cancer Treatment Planning

Maree, S., Luong, H., Kooreman, E., van Wieringen, N., Bel, A., Hinnen, K., … Alderliesten, T. (2019). Evaluation of bi-objective treatment planning for high-dose-rate prostate brachytherapy—A retrospective observer study. Brachytherapy, 18(3), 396–403. doi:10.1016/j.brachy.2018.12.010