Background: Knowledge-based (KB) planning is a promising approach to model prior planning experience and optimize radiotherapy. To enable the sharing of models across institutions, their transferability must be evaluated. This study aimed to validate KB prediction models developed by a national consortium using data from another multi-institutional consortium in a different country. Methods: Ten right whole breast tangential field (RWB-TF) models were built within the national consortium. A cohort of 20 patients from the external consortium was used for testing. Transferability was defined when the ipsilateral (IPSI) lung first principal component (PC1) was within the 10th–90th percentile of the training set. Predicted dose–volume parameters were compared with clinical dose–volume histograms (cDVHs). Results: Planning target volume (PTV) coverage strategies were comparable between the two consortia, even though significant volume differences were observed for the PTV and contralateral breast (p= 0.002 andp= 0.02, respectively). For the IPSI lung, the standard deviation of predicted mean dose/V20 Gy was 1.13 Gy/2.9% in the external consortium versus 0.55 Gy/1.6% in the training consortium. Differences between the cDVH and the predicted IPSI lung mean dose and the volume receiving more than 20 Gy (V20 Gy) were <2 Gy and <5% in 88.7% and 92.3% of cases, respectively. PC1 values fell within the 10th–90th percentile for ≥90% of patients in 6/10 models and 65–85% for the remaining 4. Conclusions: This study demonstrates the feasibility of applying RWB-TF KB models beyond the consortium in which they were developed, supporting broader clinical implementation. This retrospective study was supported by AIRC (Associazione Italiana per la Ricerca sul Cancro) and registered on ClinicalTrials.gov (NCT06317948, 12 March 2024).
背景：基于知识（KB）的规划是一种利用既往规划经验建模并优化放射治疗的有前景的方法。为实现模型在不同机构间的共享，必须评估其可移植性。本研究旨在利用来自另一国家多机构联盟的数据，验证由某国家联盟开发的KB预测模型。 方法：在国家联盟内部构建了十个右侧全乳腺切线野（RWB-TF）模型，并使用来自外部联盟的20例患者队列进行测试。可移植性定义为当同侧（IPSI）肺的第一主成分（PC1）处于训练集第10至90百分位数范围内时成立。将预测的剂量-体积参数与临床剂量-体积直方图（cDVH）进行比较。 结果：尽管两个联盟的靶区（PTV）和对侧乳腺的体积存在显著差异（分别为p=0.002和p=0.02），但两者的PTV覆盖策略具有可比性。对于同侧肺，外部联盟预测的平均剂量/V20 Gy的标准差为1.13 Gy/2.9%，而训练联盟为0.55 Gy/1.6%。在88.7%和92.3%的病例中，cDVH与预测的同侧肺平均剂量及接受超过20 Gy照射的体积（V20 Gy）之间的差异分别小于2 Gy和5%。在10个模型中，有6个模型的PC1值在≥90%的患者中处于第10-90百分位数范围内，其余4个模型的比例为65-85%。 结论：本研究证明了RWB-TF KB模型可在其开发联盟之外应用的可行性，支持更广泛的临床实施。本回顾性研究得到意大利癌症研究协会（AIRC）支持，并在ClinicalTrials.gov注册（编号NCT06317948，2024年3月12日）。
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