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Background The purpose of this study was to demonstrate the feasibility of physician driven planning in intensity modulated radiotherapy (IMRT) with a multicriteria optimization (MCO) treatment planning system and template based plan optimization. Exploiting the full planning potential of MCO navigation, this alternative planning approach intends to improve planning efficiency and individual plan quality. Methods Planning was retrospectively performed on 12 brain tumor and 10 post-prostatectomy prostate patients previously treated with MCO-IMRT. For each patient, physicians were provided with a template-based generated Pareto surface of optimal plans to navigate, using the beam angles from the original clinical plans. We compared physician generated plans to clinically delivered plans (created by dosimetrists) in terms of dosimetric differences, physician preferences and planning times. Results Plan qualities were similar, however physician generated and clinical plans differed in the prioritization of clinical goals. Physician derived prostate plans showed significantly better sparing of the high dose rectum and bladder regions (p(D1) < 0.05; D1: dose received by 1% of the corresponding structure). Physicians’ brain tumor plans indicated higher doses for targets and brainstem (p(D1) < 0.05). Within blinded plan comparisons physicians preferred the clinical plans more often (brain: 6:3 out of 12, prostate: 2:6 out of 10) (not statistically significant). While times of physician involvement were comparable for prostate planning, the new workflow reduced the average involved time for brain cases by 30%. Planner times were reduced for all cases. Subjective benefits, such as a better understanding of planning situations, were observed by clinicians through the insight into plan optimization and experiencing dosimetric trade-offs. Conclusions We introduce physician driven planning with MCO for brain and prostate tumors as a feasible planning workflow. The proposed approach standardizes the planning process by utilizing site specific templates and integrates physicians more tightly into treatment planning. Physicians’ navigated plan qualities were comparable to the clinical plans. Given the reduction of planning time of the planner and the equal or lower planning time of physicians, this approach has the potential to improve departmental efficiencies.

The aim of this study was to survey the present status and patterns of reirradiation (Re-RT) practice using external beam radiotherapy in Japan. We distributed an e-mail questionnaire to the Japanese Society for Radiation Oncology partner institutions, which consisted of part 1 (number of Re-RT cases in 2008–2012 and 2013–2018) and part 2 (indications and treatment planning for Re-RT and eight case scenarios). Of the 85 institutions that replied to part 1, 75 (88%) performed Re-RTs. However, 59 of these 75 institutions (79%) reported difficulty in obtaining Re-RT case information from their databases. The responses from 37 institutions included the number of Re-RT cases, which totaled 508 in the period from 2009 to 2013 (institution median 3; 0–235), and an increase to 762 cases in the period from 2014 to 2018 (12.5; 0–295). A total of 47 physicians responded to part 2 of the survey. Important indications for Re-RT that were considered were age, performance status, life expectancy, absence of distant metastases and time interval since previous radiotherapy. In addition to clinical decision-making factors, previous total radiation dose, volume of irradiated tissue and the biologically equivalent dose were considered during Re-RT planning. From the eight site-specific scenarios presented to the respondents, >60% of radiation oncologists agreed to perform Re-RT. Re-RT cases have increased in number, and interest in Re-RT among radiation oncologists has increased recently due to advances in technology. However, several problems exist that emphasize the need for consensus building and the establishment of guidelines for practice and prospective evaluation.

Quality assurance (QA) systems for intensity‐modulated radiation therapy (IMRT) have become standard tools in modern clinical medical physics departments. However, because formalized industry standards or recommendations from professional societies have yet to be defined, methods of IMRT QA analysis vary from institution to institution. Understanding where matters stand today is an important step toward improving the effectiveness of IMRT QA and developing standards. We therefore conducted an IMRT QA survey. This particular survey was limited to users of an electronic two‐dimensional diode array device, but we took care to keep the questions as general and useful as possible. The online survey polled institutions (one survey per institution) on a collection of questions about methods of IMRT QA. The topics were general to the IMRT QA analysis methods common to all IMRT systems; none of the questions was vendor‐ or product‐specific. Survey results showed that a significant proportion of responding institutions (32.8%) use the single‐gantry‐angle composite method for IMRT QA analysis instead of field‐by‐field analysis. Most institutions perform absolute dose comparisons rather than relative dose comparisons, with the 3% criterion being used most often for the percentage difference analysis, and the 3 mm criterion for distance‐to‐agreement analysis. The most prevalent standard for acceptance testing is the combined 3% and 3 mm criteria. A significant percentage of responding institutions report not yet having standard benchmarks for acceptance testing—specifically, 26.6%, 35.3%, and 67.6% had not yet established standard acceptance criteria for prostate, head and neck, and breast IMRT respectively. This survey helps in understanding how institutions perform IMRT QA analysis today. This understanding will help to move institutions toward more standardized acceptance testing. But before standards are defined, it would be useful to connect the conventional planar QA analyses to their resulting impact on the overall plan, using clinically relevant metrics (such as estimated deviations in dose–volume histograms). PACS numbers: 87.50.Gi, 87.52.Df, 87.52.Px, 87.53.Dq, 87.53.Tf, 87.53.Kn, 87.56.Fc

The present status of intensity-modulated radiation therapy (IMRT) for treatment of localized prostate cancer is discussed. The technological basis of IMRT and the rationale for the use in treatment of prostate cancer are described. Clinical results from the literature are presented and treatment strategies for further reduction of safety margins are outlined. Multiple planning studies demonstrated the dosimetric advantage of IMRT compared to three-dimensional conformal radiotherapy. Though randomized studies are missing, retrospective studies indicate that improved dose distributions of IMRT transfer into improved rates of local control and/or lower rates of rectal toxicity. However, with standard safety margins the benefit of IMRT seems to be limited. Image guidance is considered to be essential to reduce errors of patient setup and internal motion of the prostate.