Prospective In Silico Evaluation of Cone-Beam Computed Tomography-Guided StereoTactic Adaptive Radiation Therapy (CT-STAR) for the Ablative Treatment of Ultracentral Thoracic Disease

Schiff, Joshua; Laugeman, Eric; Stowe, H.B.; Zhao, Xiaodong; Hilliard, Jessica; Hawk, Ellie; Watkins, Jesiah; Hatscher, Casey; Badiyan, Shahed N.; Samson, Pamela; Hugo, Geoffrey D.; Robinson, C.G.; Price, Alex; Henke, Lauren E.

doi:10.1016/j.adro.2023.101226

Cited by 3 publications

(3 citation statements)

References 33 publications

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“…The median percent volume of the PTV and GTV receiving this ablative dose (BED10 = 115.5 Gy) in both the PI and PA were greater than 85% and 99%, respectively. This case report provides further evidence supporting our prior in silico work on the feasibility and dosimetric advantages of CT-STAR for ultra-central thoracic disease [ 12 ].…”

Section: Discussionsupporting

confidence: 84%

“…Several studies have demonstrated that stereotactic MRI-guided adaptive radiotherapy (SMART) can allow for the delivery of high BED10 SBRT treatments to the ultra-central thorax [ 9 - 11 ]. More recently, in silico testing on a ring gantry cone beam computed tomography (CBCT)-based radiotherapy unit capable of conducting adaptive radiotherapy suggests that CBCT-guided adaptive radiotherapy may be dosimetrically safe and feasible for patients with ultra-central thoracic disease [ 12 ]. Herein, we describe the first reported case of the use of CBCT-guided stereotactic adaptive radiotherapy (CT-STAR) in the treatment of a patient with a radiographically diagnosed, early-stage ultra-central NSCLC in a prospective clinical trial.…”

Section: Introductionmentioning

confidence: 99%

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The First Reported Case of Treating the Ultra-Central Thorax With Cone Beam Computed Tomography-Guided Stereotactic Adaptive Radiotherapy (CT-STAR)

Zhao,

Beckert,

Zhao

et al. 2024

Cureus

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Stereotactic body radiotherapy (SBRT) to the central and ultra-central thorax is associated with infrequent but potentially serious adverse events. Adaptive SBRT, which provides more precise treatment planning and inter-fraction motion management, may allow the delivery of ablative doses to ultra-central tumors with effective local control and improved toxicity profiles. Herein, we describe the first reported case of cone beam computed tomography (CBCT)-guided stereotactic adaptive radiotherapy (CT-STAR) in the treatment of ultra-central non-small cell lung cancer (NSCLC) in a prospective clinical trial (NCT05785845). An 80-year-old man with radiographically diagnosed early-stage NSCLC presented for definitive management of an enlarging ultra-central lung nodule. He was prescribed 55 Gy in five fractions with CT-STAR. A simulation was performed using four-dimensional CT, and patients were planned for treatment at end-exhale breath-hold. Treatment plans were generated using a strict isotoxicity approach, which prioritized organ at risk (OAR) constraints over target coverage. During treatment, daily CBCTs were acquired and used to generate adapted contours and treatment plans based on the patient’s anatomy-of-the-day, all while the patient was on the treatment table. The initial and adapted plans were compared using dose-volume histograms, and the superior plan was selected for treatment. The adapted plan was deemed superior and used for treatment in three out of five fractions. The adapted plan provided improved target coverage in two fractions and resolved an OAR hard constraint violation in one fraction. We report the successful treatment of a patient with ultra-central NSCLC utilizing CT-STAR. This case report builds on previously published in silico data to support the viability and dosimetric advantages of CT-STAR in the ablative treatment of this challenging tumor location. Further data are needed to confirm the toxicity and efficacy of this technique.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

The First Reported Case of Treating the Ultra-Central Thorax With Cone Beam Computed Tomography-Guided Stereotactic Adaptive Radiotherapy (CT-STAR)

Zhao,

Beckert,

Zhao

et al. 2024

Cureus

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“…Motion management is done using repeat CBCT imaging or surface monitoring (if beam gating is needed). In addition to this overarching CTgART workflow, disease-site-specific workflows have been developed and previously described [26] , [27] , [28] , [29] , [30] . For the CTgART patients, we collected the number of intended adaptive patients, with breakdown of disease sites by pancreas, abdomen, hepato-biliary, pelvis, and head & neck.…”

Section: Methodsmentioning

confidence: 99%

Initial clinical experience building a dual CT- and MR-guided adaptive radiotherapy program

Price

Schiff

Laugeman

et al. 2023

Clinical and Translational Radiation Oncology

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Unlocking the adaptive advantage: correlation and machine learning classification to identify optimal online adaptive stereotactic partial breast candidates

Pogue,

Harms,

Cardenas

et al. 2024

Phys. Med. Biol.

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Objective. Online adaptive radiotherapy (OART) is a promising technique for delivering stereotactic accelerated partial breast irradiation (APBI), as lumpectomy cavities vary in location and size between simulation and treatment. However, OART is resource-intensive, increasing planning and treatment times and decreasing machine throughput compared to the standard of care (SOC). Thus, it is pertinent to identify high-yield OART candidates to best allocate resources. Approach. Reference plans (plans based on simulation anatomy), SOC plans (reference plans recalculated onto daily anatomy), and daily adaptive plans were analyzed for 31 sequential APBI targets, resulting in the analysis of 333 treatment plans. Spearman correlations between 22 reference plan metrics and 10 adaptive benefits, defined as the difference between mean SOC and delivered metrics, were analyzed to select a univariate predictor of OART benefit. A multivariate logistic regression model was then trained to stratify high- and low-benefit candidates.Main Results. Adaptively delivered plans showed dosimetric benefit as compared to SOC plans for most plan metrics, although the degree of adaptive benefit varied per patient. The univariate model showed high likelihood for dosimetric adaptive benefit when the reference plan ipsilateral breast V15Gy exceeds 23.5%. Recursive feature elimination identified 5 metrics that predict high-dosimetric-benefit adaptive patients. Using leave-one-out cross validation, the univariate and multivariate models classified targets with 74.2% and 83.9% accuracy, resulting in improvement in per-fraction adaptive benefit between targets identified as high- and low-yield for 7/10 and 8/10 plan metrics, respectively. Significance. This retrospective, exploratory study demonstrated that dosimetric benefit can be predicted using only ipsilateral breast V15 Gy on the reference treatment plan, allowing for a simple, interpretable model. Using multivariate logistic regression for adaptive benefit prediction led to increased accuracy at the cost of a more complicated model. This work presents a methodology for clinics wishing to triage OART resource allocation.

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Prospective In Silico Evaluation of Cone-Beam Computed Tomography-Guided StereoTactic Adaptive Radiation Therapy (CT-STAR) for the Ablative Treatment of Ultracentral Thoracic Disease

Cited by 3 publications

References 33 publications

The First Reported Case of Treating the Ultra-Central Thorax With Cone Beam Computed Tomography-Guided Stereotactic Adaptive Radiotherapy (CT-STAR)

The First Reported Case of Treating the Ultra-Central Thorax With Cone Beam Computed Tomography-Guided Stereotactic Adaptive Radiotherapy (CT-STAR)

Initial clinical experience building a dual CT- and MR-guided adaptive radiotherapy program

Unlocking the adaptive advantage: correlation and machine learning classification to identify optimal online adaptive stereotactic partial breast candidates

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