A Deep Learning Model for V50%, V60%, and V66.7% Prediction in LINAC-based Treatment Planning of Single-Iso-Multiple-Targets (SIMT) Stereotactic Radiosurgery (SRS)

Brain metastases are a common complication of many types of cancer, including lung, breast, and melanoma. Approximately 30-40% of patients develop brain metastases that originate from primary systemic tumors during the course of cancer treatment. One treatment method is a LINAC-based single-isocenter multiple-target (SIMT) stereotactic radiosurgery (SRS). High plan quality has been one of the important goals in radiotherapy treatment planning. Generation of a high quality SRS treatment plan, particularly a SIMT plan, usually requires planners’ extensive planning experience, multiple runs of planning and trial-and-error, and frequent communication among planners, physicians and other radiation oncology team members. In clinical practice with potentially limited resources, SIMT SRS planning could be time-consuming and may have large variations in plan dosimetric quality. Therefore, an estimation of achievable dosimetric outcome can help reduce plan quality variation and improve planning efficiency. Assuming 20Gy in a single fraction of treatment, the volume of normal brain tissue receiving 10Gy (V50%), 12Gy (V60%), and 13Gy (V66.7%) are known predictors of brain tissue toxicity, or radionecrosis. We developed deep learning networks for the prediction of V50%, V60%, and V66.7% based on each patient’s target delineation. A prediction of achievable V10Gy, V12Gy, and V13Gy (assuming 20Gy x 1fx) can assist physicians in the determination of fractionation schemes (i.e., single fx vs. multiple fx). Such predictions can be used as guidelines for planners to generate a SIMT plan more rapidly with reduced dosimetric variability. A key technical innovation of this work is the spherical projection design: by projecting target distribution on a spherical surface, the target distribution in 3D is collapsed to a polar-azimuthal angular distribution map. This transformation enables a dimensional reduction for deep learning input without losing volumetric information. Our results indicate promising potential but there is a need for further work to improve the accuracy of our predictions.