Background/Objectives:Treatment planning for stage III non–small cell lung cancer (NSCLC) presents dosimetric challenges due to the proximity of critical structures. RapidPlan (RP), a knowledge-based planning (KBP) system, offers the potential for improved plan consistency and organ-at-risk (OAR) sparing. The objective of this study was to compare dosimetric and clinical outcomes of RP-generated plans versus manually optimized plans in patients with stage III NSCLC undergoing IMRT or VMAT.Methods:In this retrospective analysis, 50 patients treated with concurrent chemoradiation for stage III NSCLC at Hadassah Medical Center (2015–2021) were analyzed. RP plans were generated using a lung-specific model in the Eclipse treatment planning system and compared with the original clinical manual plans. Dosimetric parameters for target volumes and OARs were evaluated, and subgroup analyses were performed by technique (IMRT vs. VMAT). Toxicity and survival outcomes were analyzed, and Normal Tissue Complication Probability (NTCP) modeling was conducted.Results:RP significantly reduced mean heart dose (Δ = −2.54 Gy,p< 0.001), spinal cord maximum dose (Δ = −4.08 Gy,p< 0.001), and esophageal mean dose (Δ = −3.89 Gy,p< 0.001) compared with manual plans. Lung doses were slightly higher in RP plans (V20 Δ = +2.12%,p< 0.001). VMAT-RP plans demonstrated greater cardiac and esophageal sparing than VMAT-manual plans. RP yielded significant NTCP reductions for the heart (0.34% → 0.20%) and esophagus (16.6% → 11.5%), but no improvement for lung or spinal cord. Lung toxicity ≥ grade 2 was associated with reduced overall survival (16.2 vs. 51.8 months,p< 0.001).Conclusions:RapidPlan-based knowledge-based planning enhances OAR sparing while maintaining target coverage in locally advanced NSCLC. Slight increases in lung dose highlight the need for ongoing model refinement. An association between lung toxicity and reduced survival was observed, underscoring the impact of treatment-related morbidity on outcomes.
背景/目的：III期非小细胞肺癌（NSCLC）因肿瘤邻近关键器官结构，其治疗计划制定面临剂量学挑战。基于知识的计划系统RapidPlan（RP）有望提升计划一致性并改善危及器官保护效果。本研究旨在比较接受调强放疗或容积旋转调强放疗的III期NSCLC患者中，RP生成计划与人工优化计划在剂量学及临床结局方面的差异。 方法：本回顾性研究分析了哈达萨医疗中心（2015-2021年）接受同步放化疗的50例III期NSCLC患者。在Eclipse治疗计划系统中使用肺部专用模型生成RP计划，并与原始临床人工计划进行对比。评估靶区及危及器官的剂量学参数，并按技术类型（调强放疗 vs. 容积旋转调强放疗）进行亚组分析。分析毒性反应与生存结局，并建立正常组织并发症概率模型。 结果：与人工计划相比，RP计划显著降低心脏平均剂量（Δ = −2.54 Gy，p<0.001）、脊髓最大剂量（Δ = −4.08 Gy，p<0.001）及食管平均剂量（Δ = −3.89 Gy，p<0.001）。RP计划的肺部剂量略高（V20 Δ = +2.12%，p<0.001）。容积旋转调强放疗-RP计划较容积旋转调强放疗-人工计划展现出更优的心脏与食管保护效果。RP使心脏（0.34%→0.20%）和食管（16.6%→11.5%）的正常组织并发症概率显著降低，但肺与脊髓未见改善。≥2级肺毒性反应与总生存期缩短相关（16.2个月 vs. 51.8个月，p<0.001）。 结论：基于RapidPlan的知识型计划系统能在保持局部晚期非小细胞肺癌靶区覆盖的同时增强危及器官保护。肺部剂量的轻微升高提示需持续优化模型。观察到肺毒性与生存期缩短存在关联，凸显治疗相关并发症对临床结局的影响。
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