Online adaptive radiotherapy of urinary bladder cancer with full re-optimization to the anatomy of the day: Initial experience and dosimetric benefits

Åström, Lina M.; Behrens, Carsten; Calmels, L.; Sjöstrøm, D.; Geertsen, Poul F.; Mouritsen, Lene Sonne; Serup-Hansen, Eva; Lindberg, Henriette; Sibolt, Patrik

doi:10.1016/j.radonc.2022.03.014

Cited by 41 publications

(55 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, the global gamma passing rates (3%/2 and 3%/3 mm) with 10% dose threshold criteria were evaluated. 22 , 26 , 37 , 38 …”

Section: Methodsmentioning

confidence: 99%

“…There are three types of online ART techniques: magnetic resonance (MR)‐guided, 14 , 15 , 16 , 17 , 18 , 19 computed tomography (CT)‐on‐rails‐guided, 20 , 21 and cone‐beam CT (CBCT)‐guided approaches. 22 , 23 , 24 , 25 , 26 It is well known that MR images provide superior soft‐tissue contrast and delineation precision compared to CBCT. With the advantages of these characteristics, MR‐guided ART has been clinically applied to PC and has demonstrated its dosimetric advantages.…”

Section: Introductionmentioning

confidence: 99%

“…[28][29][30] Several studies have demonstrated the clinical efficacy of CBCT-guided ART in patients with prostate, bladder, cervical, and rectal cancer. [22][23][24][25][26] Li et al used in-house-developed graphics processing unit-based replanning system and found the dosimetric utility of daily adaptive replanning with SBRT for PC 31 ; however, they did not employ respiratory motion management techniques, and their re-optimization protocol was based on equal priority, making it difficult to adjust doses, especially to the serial organs. In addition, they did not conduct patient-specific quality assurance (QA).…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, the use of online ART, which allows us to immediately generate a new plan reflecting the daily organ deformation, has allowed the delivery of a high dose to the target safely while sparing doses to organs at risk (OARs). There are three types of online ART techniques: magnetic resonance (MR)‐guided, 14–19 computed tomography (CT)‐on‐rails‐guided, 20,21 and cone‐beam CT (CBCT)‐guided approaches 22–26 . It is well known that MR images provide superior soft‐tissue contrast and delineation precision compared to CBCT.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Potential utility of cone‐beam CT‐guided adaptive radiotherapy under end‐exhalation breath‐hold conditions for pancreatic cancer

Ogawa

Nakamura

Iramina

et al. 2022

J Applied Clin Med Phys

View full text Add to dashboard Cite

Purpose The purpose of this study was to demonstrate the potential utility of cone‐beam computed tomography (CBCT)‐guided online adaptive radiotherapy (ART) under end‐exhalation breath‐hold (EE‐BH) conditions for pancreatic cancer (PC). Methods Eleven PC patients who underwent 15‐fraction volumetric‐modulated arc therapy under EE‐BH conditions were included. Planning CT images and daily 165 CBCT images were imported into a dedicated treatment planning system. The prescription dose was set to 48 Gy in 15 fractions. The reference plan was automatically generated along with predefined clinical goals. After segmentation was completed on CBCT images, two different plans were generated: One was an adapted (ADP) plan in which re‐optimization was performed on the anatomy of the day, and the other was a scheduled (SCH) plan, which was the same as the reference plan. The dose distributions calculated using the synthetic CT created from both planning CT and CBCT were compared between the two plans. Independent calculation‐based quality assurance was also performed for the ADP plans, with a gamma passing rate of 3%/3 mm. Results All clinical goals were successfully achieved during the reference plan generation. Of the 165 sessions, gross tumor volume D 98% and clinical target volume D 98% were higher in 100 (60.1%) and 122 (74.0%) ADP fractions. In each fraction, the V 3 Gy < 1 cm 3 of the stomach and duodenum was violated in 47 (28.5%) and 48 (29.1%), respectively, of the SCH fractions, whereas no violations were observed in the ADP fractions. There were statistically significant differences in the dose–volume indices between the SCH and ADP fractions ( p < 0.05). The gamma passing rates were above 95% in all ADP fractions. Conclusions The CBCT‐guided online ART under EE‐BH conditions successfully reduced the dose to the stomach and duodenum while maintaining target coverage.

show abstract

“…In this study, the global gamma passing rates (3%/2 and 3%/3 mm) with 10% dose threshold criteria were evaluated. 22 , 26 , 37 , 38 …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Potential utility of cone‐beam CT‐guided adaptive radiotherapy under end‐exhalation breath‐hold conditions for pancreatic cancer

Ogawa

Nakamura

Iramina

et al. 2022

J Applied Clin Med Phys

View full text Add to dashboard Cite

show abstract

“…However, to make full use of these techniques, it is necessary to locate more accurately the target area and the anatomy of the OARs at each treatment. Image guidance of cone-beam computed tomography (CBCT) provides great signi cance for the validation of the location repeatability and the analysis of the volume changes of the surrounding organs in patients with locally advanced rectal cancer [5] . Some studies have shown that the actual irradiation dose received by patients is different from the planned dose, due to target dislocation caused by changes in bladder and rectal volume [6] .…”

Section: Introductionmentioning

confidence: 99%

Advantages and Robustness of Partial VMAT with Prone Position for Neoadjuvant Rectal Cancer Evaluated by CBCT-based Offline Adaptive Radiotherapy

Zhang

Peng

et al. 2023

Preprint

View full text Add to dashboard Cite

Background and purpose: This study aims to explore the advantages and robustness of the partial arc combined with prone position planning technique for radiotherapy in rectal cancer patients. Adaptive radiotherapy is recalculated and accumulated on the synthesis CT (sCT) obtained by deformable image registration (DIR) between planning CT and cone beam CT (CBCT). Full and partial volume modulation arc therapy (VMAT) with the prone position on gastrointestinal and urogenital toxicity, based on the probability of normal tissue complications (NTCP) model in rectal cancer patients were evaluated. Materials and methods: Thirty-one patients were studied retrospectively. The contours of different structures were outlined in 155 CBCT images. First, full VMAT (F-VMAT) and partial VMAT (P-VMAT) planning techniques were processed and calculated using the same optimization constraints. The Acuros XB (AXB) algorithm was used in order to generate more realistic dose distributions and DVH, considering the air cavities. Second, the Velocity 4.0 software was used to fuse the planning CT and CBCT to obtain the sCT. Then, the AXB algorithm was used in the Eclipse 13.6 software to conduct re-calculation based on the sCT to obtain the corresponding dose. Furthermore, the LKB NTCP model was used to analyze its radiobiological side effects on the bladder and the bowel bag. Results: With a CTV coverage of 98%, when compared with F-VMAT, P-VMAT with the prone position technique can effectively reduce the mean dose of the bladder and the bowel bag. The LKB NTCP model showed that the P-VMAT combined with the prone planning technique resulted in a significantly lower complication probability of the bladder (1.88±2.08vs1.62±1.41, P=0.041) and the bowel bag (1.77 ± 2.90vs1.57 ± 2.36, P<0.001) than the F-VMAT. In terms of robustness, the P-VMAT is more robust than the F-VMAT, considering the fact that fewer changes were observed in the dose of the CTV, the bladder and the bowel bag. Conclusion: This study analyzed the advantages and robustness of the P-VMAT in the prone position from three aspects, based on the sCT fused by CBCT. Whether it is in regards to dosimetry, radiobiological effects or robustness, P-VMAT in the prone position has shown great advantages.

show abstract

Evaluation and correlation of patient movement during online adaptive radiotherapy with CBCT and a surface imaging system

Stanley,

Covington,

Harms

et al. 2023

J Applied Clin Med Phys

View full text Add to dashboard Cite

PurposeWith the clinical implementation of kV‐CBCT‐based daily online‐adaptive radiotherapy, the ability to monitor, quantify, and correct patient movement during adaptive sessions is paramount. With sessions lasting between 20–45 min, the ability to detect and correct for small movements without restarting the entire session is critical to the adaptive workflow and dosimetric outcome. The purpose of this study was to quantify and evaluate the correlation of observed patient movement with machine logs and a surface imaging (SI) system during adaptive radiation therapy.MethodsTreatment machine logs and SGRT registration data log files for 1972 individual sessions were exported and analyzed. For each session, the calculated shifts from a pre‐delivery position verification CBCT were extracted from the machine logs and compared to the SGRT registration data log files captured during motion monitoring. The SGRT calculated shifts were compared to the reported shifts of the machine logs for comparison for all patients and eight disease site categories.ResultsThe average (±STD) net displacement of the SGRT shifts were 2.6 ± 3.4 mm, 2.6 ± 3.5 mm, and 3.0 ± 3.2 in the lateral, longitudinal, and vertical directions, respectively. For the treatment machine logs, the average net displacements in the lateral, longitudinal, and vertical directions were 2.7 ± 3.7 mm, 2.6 ± 3.7 mm, and 3.2 ± 3.6 mm. The average difference (Machine–SGRT) was −0.1 ± 1.8 mm, 0.2 ± 2.1 mm, and −0.5 ± 2.5 mm for the lateral, longitudinal, and vertical directions. On average, a movement of 5.8 ± 5.6 mm and 5.3 ± 4.9 mm was calculated prior to delivery for the CBCT and SGRT systems, respectively. The Pearson correlation coefficient between CBCT and SGRT shifts was r = 0.88. The mean and median difference between the treatment machine logs and SGRT log files was less than 1 mm for all sites.ConclusionSurface imaging should be used to monitor and quantify patient movement during adaptive radiotherapy.

show abstract

Online adaptive radiotherapy of urinary bladder cancer with full re-optimization to the anatomy of the day: Initial experience and dosimetric benefits

Cited by 41 publications

References 39 publications

Potential utility of cone‐beam CT‐guided adaptive radiotherapy under end‐exhalation breath‐hold conditions for pancreatic cancer

Potential utility of cone‐beam CT‐guided adaptive radiotherapy under end‐exhalation breath‐hold conditions for pancreatic cancer

Advantages and Robustness of Partial VMAT with Prone Position for Neoadjuvant Rectal Cancer Evaluated by CBCT-based Offline Adaptive Radiotherapy

Evaluation and correlation of patient movement during online adaptive radiotherapy with CBCT and a surface imaging system

Contact Info

Product

Resources

About