Evaluation of bi-objective treatment planning for high-dose-rate prostate brachytherapy—A retrospective observer study

Stefanus C. Maree, Ngoc Hoang Luong, Ernst S. Kooreman, Niek van Wieringen, Arjan Bel, Karel A. Hinnen, Henrike Westerveld, Bradley R. Pieters, Peter A.N. Bosman, Tanja Alderliesten

Research output: Contribution to journalArticleAcademicpeer-review

24 Citations (Scopus)


Purpose: Bi-objective treatment planning for high-dose-rate prostate brachytherapy is a novel treatment planning method with two separate objectives that represent target coverage and organ-at-risk sparing. In this study, we investigated the feasibility and plan quality of this method by means of a retrospective observer study. Methods and Materials: Current planning sessions were recorded to configure a bi-objective optimization model and to assess its applicability to our clinical practice. Optimization software, GOMEA, was then used to automatically generate a large set of plans with different trade-offs in the two objectives for each of 18 patients treated with high-dose-rate prostate brachytherapy. From this set, five plans per patient were selected for comparison to the clinical plan in terms of satisfaction of planning criteria and in a retrospective observer study. Three brachytherapists were asked to evaluate the blinded plans and select the preferred one. Results: Recordings demonstrated applicability of the bi-objective optimization model to our clinical practice. For 14/18 patients, GOMEA plans satisfied all planning criteria, compared with 4/18 clinical plans. In the observer study, in 53/54 cases, a GOMEA plan was preferred over the clinical plan. When asked for consensus among observers, this ratio was 17/18 patients. Observers highly appreciated the insight gained from comparing multiple plans with different trade-offs simultaneously. Conclusions: The bi-objective optimization model adapted well to our clinical practice. GOMEA plans were considered equal or superior to the clinical plans. In addition, presenting multiple high-quality plans provided novel insight into patient-specific trade-offs.

Original languageEnglish
Pages (from-to)396-403
Number of pages8
Issue number3
Publication statusPublished - 1 May 2019


  • Bi-objective optimization
  • Brachytherapy
  • HDR
  • Observer study
  • Prostate neoplasm
  • Treatment planning

Cite this