{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T07:49:33Z","timestamp":1773733773580,"version":"3.50.1"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007210","name":"Varian Medical Systems","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007210","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The performance of knowledge-based autoplanning depends on historical plans used to train the autoplanning models. Here, we investigate the applicability of an existing RapidPlan (RP) model for head and neck cancer to a novel planning and delivery solution (RapidArc Dynamic, RAD), which has the potential to improve plan quality through the integration of new degrees of freedom. RAD integrates static-angle modulated ports and a dynamic collimator in volumetric-modulated arc therapy (VMAT) fields.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>A cohort of 48 oropharyngeal cancer (OPC) patients was retrospectively included in the planning study. Organ-at-risk (OAR) sparing was evaluated for VMAT and RAD, respectively, using both a VMAT-based RP model and a RAD-based RP model, resulting in four plans per patient: VMAT (RP-VMAT), VMAT (RP-RAD)), RAD (RP-VMAT) and RAD (RP-RAD). Differences were assessed with the related-samples Friedman\u2019s two-way ANOVA test by ranks, correcting the p value for multiple testing (p \u2264 0.05 considered significant).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For RAD plans, the RAD-based RP model improved the sparing of all OAR (p \u2264 0.001) except the parotids. However, the RAD plans were at least equivalent to the VMAT plans when optimizing with RP-VMAT, indicating the safety of initially implementing RAD with a VMAT-based RP model. In addition, when optimizing with RP-RAD, all OAR except the trachea were significantly better spared with RAD (RP-RAD) compared to VMAT (RP-RAD) (p = 0.039 for the esophagus and &amp;lt; 0.001 for the remaining OAR), with a median reduction of Dmean by 4.8 Gy and 3.5 Gy, respectively, for the larynx and the constrictor muscle. There was also a significant reduction in the estimated risk of dysphagia (1.9 pp) and acute mucositis (1.3 pp) (p \u2264 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>VMAT-based RP models appear to remain applicable for optimization with the novel RAD solution until RAD-specific RP models are developed. Furthermore, RAD shows promise for OPC in terms of sparing of midline OARs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1755913","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T05:25:20Z","timestamp":1773725120000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Can knowledge-based autoplanning keep up with advances in radiotherapy optimization for oropharyngeal cancer?"],"prefix":"10.3389","volume":"16","author":[{"given":"Vanessa","family":"Panettieri","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Peter MacCallum Cancer Centre","place":["Melbourne, VIC, Australia"]},{"name":"Sir Peter MacCallum Department of Oncology, The University of Melbourne","place":["Melbourne, VIC, Australia"]},{"name":"School of Translational Medicine, Monash University","place":["Melbourne, VIC, Australia"]},{"name":"Department of Medical Imaging and Radiation Sciences, Monash University","place":["Clayton, VIC, Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olubunmi","family":"Olumuyiwa","sequence":"additional","affiliation":[{"name":"Department of Physics, Stockholm University","place":["Stockholm, Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars","family":"S\u00f6dergren","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and Medical Physics, Karolinska University Hospital","place":["Stockholm, Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"S\u00f6derstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and Medical Physics, Karolinska University Hospital","place":["Stockholm, Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mimmi-Carolin","family":"Bolin","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and Medical Physics, Karolinska University Hospital","place":["Stockholm, Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianne","family":"Falk","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and Medical Physics, Karolinska University Hospital","place":["Stockholm, Sweden"]},{"name":"Department of Oncology Pathology, Karolinska Institutet","place":["Stockholm, Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Embring","sequence":"additional","affiliation":[{"name":"Department of Oncology Pathology, Karolinska Institutet","place":["Stockholm, Sweden"]},{"name":"Department of Radiotherapy, Karolinska University Hospital","place":["Stockholm, Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Onjukka","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and Medical Physics, Karolinska University Hospital","place":["Stockholm, Sweden"]},{"name":"Department of Oncology Pathology, Karolinska Institutet","place":["Stockholm, Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13194912","article-title":"An Updated Review on Head and Neck Cancer Treatment with Radiation Therapy","volume":"13","author":"Anderson","year":"2021","journal-title":"Cancers"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminoncol.2019.07.002","article-title":"Modern radiotherapy for head and neck cancer","volume":"46","author":"Alterio","year":"2019","journal-title":"Semin Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.28372","article-title":"Improved survival using intensity-modulated radiation therapy in head and neck cancers: a SEER-Medicare analysis","volume":"120","author":"Beadle","year":"2014","journal-title":"Cancer"},{"key":"B4","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1002\/lio2.642","article-title":"Dosimetric justification for the use of volumetric modulated arc therapy in head and neck cancer-A systematic review of the literature","volume":"6","author":"Buciuman","year":"2021","journal-title":"Laryngoscope Investig Otolaryngol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2012.05.006","article-title":"Intensity-modulated radiotherapy in the treatment of head and neck cancer","volume":"24","author":"O\u2019Sullivan","year":"2012","journal-title":"Clin Oncol (R Coll Radiol)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1002\/acm2.12652","article-title":"Evaluation of auto-planning in IMRT and VMAT for head and neck cancer","volume":"20","author":"Ouyang","year":"2019","journal-title":"J Appl Clin Med Phys"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2008.12.033","article-title":"Volumetric Intensity-Modulated Arc Therapy Vs. Conventional Imrt in Head-and-Neck Cancer: A Comparative Planning and Dosimetric Study","volume":"74","author":"Verbakel","year":"2009","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1093\/jrr\/rrw047","article-title":"IMRT for head and neck cancer: reducing xerostomia and dysphagia","volume":"57","author":"Wang","year":"2016","journal-title":"J Radiat Res"},{"key":"B9","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/s13014-017-0808-x","article-title":"RapidPlan head and neck model: the objectives and possible clinical benefit","volume":"12","author":"Fogliata","year":"2017","journal-title":"Radiat Oncol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1016\/j.ctro.2016.08.001","article-title":"Automatic treatment planning improves the clinical quality of head and neck cancer treatment plans","volume":"1","author":"Hansen","year":"2016","journal-title":"Clin Transl Radiat Oncol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1016\/j.prro.2011.11.012","article-title":"Variation in external beam treatment plan quality: An inter-institutional study of planners and planning systems","volume":"2","author":"Nelms","year":"2012","journal-title":"Pract Radiat Oncol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2996","DOI":"10.1200\/JCO.2009.27.4498","article-title":"Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck cancer: results from TROG 02.02","volume":"28","author":"Peters","year":"2010","journal-title":"J Clin Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.11.014","article-title":"Evaluation of a knowledge-based planning solution for head and neck cancer","volume":"91","author":"Tol","year":"2015","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1002\/jmrs.420","article-title":"Rolling out RapidPlan: What we\u2019ve learnt","volume":"67","author":"Van Gysen","year":"2020","journal-title":"J Med Radiat Sci"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1118\/1.4908224","article-title":"Optimization approaches to volumetric modulated arc therapy planning","volume":"42","author":"Unkelbach","year":"2015","journal-title":"Med Phys"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.meddos.2018.09.003","article-title":"Nasopharyngeal carcinoma radiotherapy with hybrid technique","volume":"44","author":"Akbas","year":"2019","journal-title":"Med Dosimetry"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1118\/1.4808153","article-title":"FusionArc optimization: A hybrid volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) planning strategy","volume":"40","author":"Matuszak","year":"2013","journal-title":"Med Phys"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e86280","DOI":"10.7759\/cureus.86280","article-title":"Comparison of Advanced Dynamic Arc Therapy With Collimator Rotation and Fixed Integrated Gantry Positions to the Standard of Care Across Five Treatment Sites","volume":"17","author":"Clark","year":"2025","journal-title":"Cureus"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e70036","DOI":"10.1002\/acm2.70036","article-title":"Automatic skin flash optimization in breast and chestwall VMAT with static angle modulated ports: Effect of HU and flash margin size on plan quality and robustness","volume":"26","author":"Hubley","year":"2025","journal-title":"J Appl Clin Med Phys"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2025.100810","article-title":"Performance evaluation of a new automated skin flash method for radiotherapy of breast cancer","volume":"35","author":"Nykanen","year":"2025","journal-title":"Phys Imaging Radiat Oncol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2025.100833","article-title":"Rotational arc treatments with static ports and dynamic collimation reduces cardiopulmonary dose for esophageal cancer patients and diminishes model-based predicted benefit of proton therapy","volume":"36","author":"Populaire","year":"2025","journal-title":"Phys Imag Radiat Onc"},{"key":"B22","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.radonc.2020.09.033","article-title":"Radiotherapy Treatment plannINg study Guidelines (RATING): A framework for setting up and reporting on scientific treatment planning studies","volume":"153","author":"Hansen","year":"2020","journal-title":"Radiother Oncol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2016.06.022","article-title":"Clinical validation and benchmarking of knowledge-based IMRT and VMAT treatment planning in pelvic anatomy","volume":"120","author":"Hussein","year":"2016","journal-title":"Radiother Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2012.11.013","article-title":"Quantitative analysis of normal tissue effects in the clinic (QUANTEC) guideline validation using quality of life questionnaire datasets for parotid gland constraints to avoid causing xerostomia during head-and-neck radiotherapy","volume":"106","author":"Lee","year":"2013","journal-title":"Radiother Oncol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2011.08.009","article-title":"Predictive modelling for swallowing dysfunction after primary (chemo)radiation: results of a prospective observational study","volume":"105","author":"Christianen","year":"2012","journal-title":"Radiother Oncol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.radonc.2011.12.027","article-title":"Dose-response analysis of acute oral mucositis and pharyngeal dysphagia in patients receiving induction chemotherapy followed by concomitant chemo-IMRT for head and neck cancer","volume":"103","author":"Bhide","year":"2012","journal-title":"Radiother Oncol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.14338\/IJPT-20-00089.1","article-title":"National Protocol for Model-Based Selection for Proton Therapy in Head and Neck Cancer","volume":"8","author":"Langendijk","year":"2021","journal-title":"Int J Part Ther"},{"key":"B28","doi-asserted-by":"publisher","first-page":"021716","DOI":"10.1118\/1.4861821","article-title":"Quantification of beam complexity in intensity-modulated radiation therapy treatment plans","volume":"41","author":"Du","year":"2014","journal-title":"Med Phys"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1002\/mp.12810","article-title":"Tolerance limits and methodologies for IMRT measurement-based verification QA: Recommendations of AAPM Task Group No. 218","volume":"45","author":"Miften","year":"2018","journal-title":"Med Phys"},{"key":"B30","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.ejmp.2017.03.002","article-title":"Knowledge-based treatment planning: An inter-technique and inter-system feasibility study for prostate cancer","volume":"36","author":"Cagni","year":"2017","journal-title":"Phys Med"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1002\/jmrs.376","article-title":"Parotid sparing in RapidPlan Oropharynx models: To split or not to split","volume":"67","author":"O\u2019Toole","year":"2020","journal-title":"J Med Radiat Sci"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3857\/roj.2020.00619","article-title":"Dosimetric comparative study of 3DCRT, IMRT, VMAT, Ecomp, and Hybrid techniques for breast radiation therapy","volume":"38","author":"Chen","year":"2020","journal-title":"Radiat Oncol J"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.4999\/uhod.172064","article-title":"Hybrid Arc Could Combine the Benefits of IMRT and VMAT to Deliver a Fast, Conformal, Homogeneous Treatment in Non-Small Cell Lung Cancer without Limitations of Low Dose Bath: A Planning Study","volume":"27","author":"Saglam","year":"2017","journal-title":"Uluslar Hematol Onkol Derg"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/940102","article-title":"A hybrid IMRT\/VMAT technique for the treatment of nasopharyngeal cancer","volume":"2015","author":"Zhao","year":"2015","journal-title":"BioMed Res Int"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/613060","article-title":"An IMRT\/VMAT Technique for Nonsmall Cell Lung Cancer","volume":"2015","author":"Zhao","year":"2015","journal-title":"BioMed Res Int"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2023.109958","article-title":"Considerations for study design in the DAHANCA 35 trial of protons versus photons for head and neck cancer","volume":"190","author":"Friborg","year":"2024","journal-title":"Radiother Oncol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"95","DOI":"10.14338\/20-00092","article-title":"NTCP Modeling of Late Effects for Head and Neck Cancer: A Systematic Review","volume":"8","author":"Stieb","year":"2021","journal-title":"Int J Part Ther"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-014-0241-z","article-title":"Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD Statement","volume":"13","author":"Collins","year":"2015","journal-title":"BMC Med"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2021.04.006","article-title":"Independent external validation using the EORTC HNCG-ROG 1219 DAHANCA trial data of NTCP models for acute oral mucositis","volume":"161","author":"Sharabiani","year":"2021","journal-title":"Radiother Oncol"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2020.1856409","article-title":"Optimal beam angle selection and knowledge-based planning significantly reduces radiotherapy dose to organs at risk for lung cancer patients","volume":"60","author":"Hoffmann","year":"2021","journal-title":"Acta Oncol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.radonc.2020.09.038","article-title":"What is plan quality in radiotherapy? The importance of evaluating dose metrics, complexity, and robustness of treatment plans","volume":"153","author":"Hernandez","year":"2020","journal-title":"Radiother Oncol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.ejmp.2019.05.024","article-title":"Use of metrics to quantify IMRT and VMAT treatment plan complexity: A systematic review and perspectives","volume":"64","author":"Antoine","year":"2019","journal-title":"Phys Med"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1755913\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T05:25:22Z","timestamp":1773725122000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1755913\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,17]]},"references-count":42,"alternative-id":["10.3389\/fonc.2026.1755913"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1755913","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,17]]},"article-number":"1755913"}}