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Updates to Radiotherapy Outcomes Estimator (ROE) for Protocol Comparison and Display of Clinical Constraints

A Iyer*, A Jackson , A Apte , M Thor , A Fontanella , J Oh , J Deasy , Memorial Sloan-Kettering Cancer Center, New York, NY


(Sunday, 7/29/2018) 3:00 PM - 6:00 PM

Room: Exhibit Hall

Purpose: To present the updates to CERR’s Radiotherapy Outcomes Estimator (ROE) plug-in.

Methods: Several new features have been introduced with the aim to extend the clinical utility of ROE. These include: (1) Protocol comparison: An interface to identify the most suitable protocol among multiple user-defined protocols by comparing the maximum achievable Tumor Control Probability (TCP) or Biological Equivalent Dose (BED), while still satisfying clinical constraints. (2) Display of clinical constraints: ROE incorporates user-defined limits on NTCP, and dose-volume constraints. The first operative clinical limit for each protocol is displayed by default, with an additional interface to view selected constraints, or to cycle through available constraints in order of their violation. (3) Summary of constraint violations: Expandable tool-tips displaying violated constraints, scaled fraction size or fraction number resulting in violation, and the corresponding NTCP and tumor BED. (4) Impact of planned fraction number: In addition to fraction size, ROE provides the ability to analyze changes in TCP and NTCP as a function of planned fraction number. (5) Updates to models: The syntax for defining models was altered to allow for multiple structures. Additionally, the list of available models was expanded to include NTCP models for esophagitis, pneumonitis, dysphagia, radiation-induced liver disease, rectal bleeding, urinary toxicity, and erectile dysfunction; and TCP models for the lung and prostate. (6) Model validation: Unit tests are available to validate predictions against expected outcomes using single-voxel structures with manually-input parameters including dose. (7) Bio-normalization of dose: Where possible, planned doses are converted to the fraction number used in the modeled dataset. Alternatively, EQD2 conversion is used.

Results: The new features and updates are available as open source, GPL-copyright software at

Conclusion: We have developed a flexible tool that provides several pre-defined and validated models to explore radiotherapy outcomes and aid in protocol comparison.

Funding Support, Disclosures, and Conflict of Interest: This research was partially funded by NIH grant 1R01CA198121 and NIH/NCI Cancer Center Support grant P30 CA008748.


Dose Response, Treatment Planning, NTCP


Not Applicable / None Entered.

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