Simultaneous catheter and multicriteria optimization for HDR cervical cancer brachytherapy with a complex intracavity/interstitial applicator

Abstract Background Complex intracavity and interstitial (IC/IS) applicators, such as the Venezia applicator, can improve the HR‐CTV coverage while adequately protecting organs at risk in the treatment of cervical cancer with high‐dose‐rate (HDR) brachytherapy. Although the Venezia applicator offers more choice for catheter selection, commercially available catheter and dose optimization algorithms are still missing for complex applicators. Moreover, studies on catheter and dose optimization for IC/IS implants in the treatment of cervical cancer are still limited. Purpose This work aims to combine a GPU‐based multi‐criteria optimization (gMCO) algorithm with a sparse catheter (SC) optimization algorithm for the Venezia applicator. Methods Fifty‐eight cervical cancer patients who received 28 Gy in 4 fx of HDR brachytherapy with the Venezia applicator (combination to external beam radiation therapy) are retrospectively revisited. The modelization of the applicator is done by virtually reconstructing all the IS catheters passing through the ring. Template catheters are reconstructed using an in‐house python script. To perform simultaneous MCO and SC optimization (SC+MCO), the objective function includes aggregated dose objectives in a weighted sum and a group sparsity term that individually penalizes the contribution of IS catheters. Plans generated with the SC+MCO algorithm are compared with plans generated with MCO using clinical catheters (CC+MCO) and the clinical plans (CP). The EMBRACE II soft constraints (planning aims) and hard constraints (limits for prescribed dose) are used as plan evaluation criteria. Results CC+MCO gives the most important gain with an increase up to 20.7% in meeting all EMBRACE II soft constraints compared with CP. The SC+MCO algorithm (adding catheter optimization to MCO) provides a second order increase (up to 12.1% with total acceptance rate of 60.3% or 35/58) in the acceptance rate versus CC+MCO (total increase of 32.8% vs. CP). Acceptance rate in EMBRACE II hard constraints is 98.3% (57/58) for both CC+MCO and SC+MCO versus 91.4% (53/58) for CP. The median SC+MCO optimization time is 11 s to generate a total of 5000 Pareto‐optimal plans with different catheter configurations (position and number) for each fraction. Conclusions Simultaneous catheter and MCO optimization is clinically feasible for HDR cervical cancer brachytherapy using the Venezia applicator. Clinical catheter configurations could be improved and/or the catheter number could be reduced without decreasing plan quality using SC+MCO compared with the CP.