Efficiency evaluation of a Commercial Software for Breast Cancer plus Lymph Nodes Radiotherapy Planning

The emergence of automation tools to assist in the routine tasks of Radiation Therapy centers has become increasingly prominent in recent years, particularly in sites with a high incidence of cancer. Various commercial software solutions are available for automated treatment planning; among these, EZFluence from Radformation Inc. (New York, USA) stands out as a tool used for achieving dose homogeneity within the target tissue by generating sliding window or Field-in-Field Beams. Therefore, the objective of this study is to assess the efficiency gains associated with the implementation of the EZFluence tool in clinical practice. Two experienced physicists retrospectively manually planned treatment for ten patients, with breast cancer and eight patients with breast cancer and lymph node involvement. The time taken to create clinically acceptable plans was recorded. Additionally, the time taken to generate plans using EZFluence was documented. The treatment protocol adopted for this study consists of hypofractionation, with 40.05 Gy delivered in 15 fractions. The mean time required to generate treatment plans decreased from 15 minutes and 57 seconds ± 4 minutes and 11 seconds to 8 minutes and 40 seconds ± 2 minutes and 48 seconds for plans generated using EZFluence for breast cancer patients without lymph node involvement (p-value < 0.01) and from 23 minutes and 52 seconds ± 4 minutes and 47 seconds for manual planning to 15 minutes and 56 seconds ± 1 minute and 26 seconds for plans generated using EZFluence for breast cancer patients with lymph node involvement (p-value < 0.01). Furthermore, the dosimetric quality of the plans was found to be comparable, once all the manual and automatic plans were adjusted to meet clinical acceptability criteria. The use of EZFluence has been demonstrated to enhance planning efficiency while upholding the dosimetric quality of treatment plans.