In inverse radiotherapy treatment planning, the Pareto front is the set of optimal solutions to the multi-criteria problem of adequately irradiating the planning target volume (PTV) while reducing dose to organs at risk (OAR). The Pareto front depends on the chosen optimisation parameters whose influence (clinically relevant versus not clinically relevant) is investigated in this paper.
Thirty-one prostate cancer patients treated at our clinic were randomly selected. We developed an in-house Python script that controlled the commercial treatment planning system RayStation to calculate directly deliverable Pareto fronts. We calculated reference Pareto fronts for a given set of objective functions, varying the PTV coverage and the mean dose of the primary OAR (rectum) and fixing the mean doses of the secondary OARs (bladder and femoral heads). We calculated the fronts for different sets of objective functions and different mean doses to secondary OARs. We compared all fronts using a specific metric (clinical distance measure).
The in-house script was validated for directly deliverable Pareto front calculations in two and three dimensions. The Pareto fronts depended on the choice of objective functions and fixed mean doses to secondary OARs, whereas the parameters most influencing the front and leading to clinically relevant differences were the dose gradient around the PTV, the weight of the PTV objective function, and the bladder mean dose.
Our study suggests that for multi-criteria optimisation of prostate treatments using external therapy, dose gradient around the PTV and bladder mean dose are the most influencial parameters.