Abstract
Radiation treatment planning requires balancing competing objectives to satisfy clinical criteria while accommodating physicians' preferences. This study aims to develop an evidence-driven, multi-agent compound AI system that integrates DRL-based automated treatment planning with LLM-based conversational plan refinement for proton PBS therapy. A policy network trained using PPO first generates multiple plans without human intervention, from which one is selected as the target plan and the others serve as references for subsequent refinements. For challenging cases requiring further adjustments, an LLM-based multi-agent system enables plan refinement through natural language interactions. The system comprises a planning agent that recommends evidence-supported adjustments, a chatbot providing a unified conversational interface, and an evaluation agent that retrieves clinical metrics and identifies constraint violations. To enhance domain-specific reasoning, the planning agent based on Qwen3-14B is designed to justify its recommendations using evidence from previously generated plans and post-trained on task-specific data using SFT and GRPO. The framework was trained and evaluated using 21 patients with H&N cancers, with 5 PPO-generated plans per patient. Of these, 50 plans were selected for instruction-guided refinement. Compared with the base LLM, the post-trained Qwen3-14B demonstrated improved instruction-following, information retrieval and domain-specific reasoning capabilities. The resulting adjustments more effectively improved user-prioritized objectives while limiting deterioration in competing objectives, yielding more clinically appropriate trade-offs in patient-specific plan refinement. The proposed compound AI system provides a user-friendly planning platform, offering a promising approach to personalized proton PBS treatment planning.
Abstract (translated)
URL
https://arxiv.org/abs/2610.29010
