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Contouring Organs-at-risk (OAR) is a laborious process that often delays radiation treatment plan design. A few FDA approved auto-segmentation software (AS) have become available. Our goal is to validate such a commercial AS in thoracic cancer OAR contouring. We installed an externally trained AS into our AI computer. Validation is judged by our current gold standard contouring (GSC) by two experienced planners and one radiation oncologist (RO). We used 30 lung or esophageal cancer planning datasets to generate GSC and AI contours (AIC). Objective analysis included Dice Similarity Coefficient (DSC) and 95% Hausdorff distance (95% HD). Subjective analysis was done by two ROs to score 1 to 3 on all OARs by GSC and AIC that were randomly blended and anonymized with consistent nomenclature (1: no modification required; 2: minor modification required but adequate for clinical use; 3: major modification required and not suitable for clinical use). Most retrospective peer-reviewed OAR contours neglected some less important structures on CT slices typically far away from the target of the 30 patients, median age 75 years (54-90), including 22 males and 8 females, with 28 average pixel density data-sets from 4D-CT for lung cancer and 2 fast helical scans for esophageal cancer. We had to re-contour most of the OARs to generate GSC. The median GSC and AIC contouring times were 60 vs 2.5 minutes for up to 12 OARs, some of which were only partially available in the datasets (e.g., stomach and liver). Due to the inconsistency of contouring organs far away from the planning target volume, we only chose six main OARs for initial validation and analysis. Comparing AICs to GSCs, the mean DSC and 95% HD were: esophagus 0.61 and 16 mm, heart 0.85 and 13.1 mm, left lung 0.97 and 5.9 mm, right lung 0.96 and 5.7 mm, spinal cord 0.82 and 10.7 mm, trachea and proximal bronchial tree (TPB) 0.67 and 19.1 mm, respectively. The two ROs agreed with 100% of four OARs on GSC, i.e., both RO scoring 1 or 2 meaning adequate for planning purpose, with the exception of esophagus having 96.7% vs 100% and right lung having 100% vs 96.7% agreement, respectively. They had less agreement on AIC, with esophagus 90% vs 60%, heart 83.3% vs 86.7%, left lung 100% vs 96.7%, right lung 100% vs 96.7%, spinal cord 100% vs 100%, TPB 96.7% vs 86.7% agreement, respectively. The inter-observer variabilities are significantly larger when ROs evaluated esophagus and heart AIC (p=0.046 and 0.05, respectively, Student's t-test). The accuracy of an externally trained deep learning-based AS might not be acceptable without in-house training from local protocols. Retrospective peer-reviewed OAR contours might not be good enough in the training and evaluation of AS. Our future work involves training AS using our GSCs and re-evaluating its performance. [ABSTRACT FROM AUTHOR]

The low α\β ratio of 1.2-2 for prostate cancer (PCa) suggests high radiation-fraction sensitivity and predicts a therapeutic advantage of lager fraction size. We have recently shown (PCS5) that high risk prostate cancer patients can safely and effectively be treated with moderate hypofractionated radiation therapy (HF-RT). To date there has been no phase-III randomized clinical-trial comparing moderately HF-RT with EBRT and HDR boost (HDRB). We are reporting the acute safety of EBRT+HDRB compared to moderate HF-RT in this phase III Canadian trial. From January 2015–June 2022, 308 high-risk localized PCa patients were randomized to receive either HF-RT or EBRT+HDRB. All patients received neo-adjuvant, concurrent, and long-term adjuvant androgen deprivation therapy (ADT). EBRT+HDRB consisted of 46 Gy in 2 Gy per fraction to the pelvis and a 15 Gy in one fraction HDR boost within 3 weeks of EBRT. HF-RT include concomitant dose escalation of 68 Gy in 2.72 Gy per fraction to the prostate, and 45 Gy in 1.8 Gy per fraction to the pelvic lymph-nodes. Of the 308 patients, 148 received HF-RT and 144 EBRT+ HDRB. The remainder either withdrew from the study or were treated with standard (2 Gy per fraction) fractionation for technical reasons. In both intention to treat and as treated analysis, using log-Rank, there were more grade 1 or worse (G1+) acute GI and GU events and more G2+ acute GI events in the HF-RT than EBRT+HDRB. As treated analysis the acute G1+ and G2+ GI events were 92 vs 77 (60.1% vs. 53.5%; p < 0.017) and 21 vs 10 (13.7% vs. 6.9%; p = 0.052), respectively for HF-RT and EBRT + HDRB. Similarly, the G1+ acute GU events were 123 vs. 101 (80.4% vs.70.1%; p < 0.001) respectively for HF-RT and EBRT+HDRB. There were only four G3 GI and one G3 GU acute toxicities in both arms. No grade 4 toxicities were reported. This is the first study of EBRT+HDRB compared to moderate HF dose escalated RT in high-risk prostate cancer patients treated with long-term ADT and pelvic RT. Our results demonstrate that both treatment approaches are well-tolerated and that EBRT+HDRB carries less G2+ GI and G1+ GU acute toxicities. [ABSTRACT FROM AUTHOR]