UNLABELLED: Background: Patients with urinary bladder cancer often display large changes in the shape and size of their bladder target during a course of radiotherapy (RT), making adaptive RT (ART) appealing for this tumour site. We are conducting a clinical phase II trial of daily plan selection-based ART for bladder cancer and here report dose-volume data from the first 20 patients treated in the trial. MATERIAL AND METHODS: All patients received 60 Gy in 30 fractions to the bladder; in 13 of the patients the pelvic lymph nodes were simultaneously treated to 48 Gy. Daily patient set-up was by use of cone beam computed tomography (CBCT) guidance. The first 5 fractions were delivered with large, population-based (non-adaptive) margins. The bladder contours from the CBCTs acquired in the first 4 fractions were used to create a patient-specific library of three plans, corresponding to a small, medium and large size bladder. From fraction 6, daily online plan selection was performed, where the smallest plan covering the bladder was selected prior to each treatment delivery. A total of 600 treatment fractions in the 20 patients were evaluated. RESULTS: Small, medium and large size plans were used almost equally often, with an average of 10, 9 and 11 fractions, respectively. The median volume ratio of the course-averaged PTV (PTV-ART) relative to the non-adaptive PTV was 0.70 (range: 0.46-0.89). A linear regression analysis showed a 183 cm(3) (CI 143-223 cm(3)) reduction in PTV-ART compared to the non-adaptive PTV (R(2) = 0.94). CONCLUSION: Daily adaptive plan selection in RT of bladder cancer results in a considerable normal tissue sparing, of a magnitude that we expect will translate into a clinically significant reduction of the treatment-related morbidity.
UNLABELLED: Background: Patients with urinary bladder cancer often display large changes in the shape and size of their bladder target during a course of radiotherapy (RT), making adaptive RT (ART) appealing for this tumour site. We are conducting a clinical phase II trial of daily plan selection-based ART for bladder cancer and here report dose-volume data from the first 20 patients treated in the trial. MATERIAL AND METHODS: All patients received 60 Gy in 30 fractions to the bladder; in 13 of the patients the pelvic lymph nodes were simultaneously treated to 48 Gy. Daily patient set-up was by use of cone beam computed tomography (CBCT) guidance. The first 5 fractions were delivered with large, population-based (non-adaptive) margins. The bladder contours from the CBCTs acquired in the first 4 fractions were used to create a patient-specific library of three plans, corresponding to a small, medium and large size bladder. From fraction 6, daily online plan selection was performed, where the smallest plan covering the bladder was selected prior to each treatment delivery. A total of 600 treatment fractions in the 20 patients were evaluated. RESULTS: Small, medium and large size plans were used almost equally often, with an average of 10, 9 and 11 fractions, respectively. The median volume ratio of the course-averaged PTV (PTV-ART) relative to the non-adaptive PTV was 0.70 (range: 0.46-0.89). A linear regression analysis showed a 183 cm(3) (CI 143-223 cm(3)) reduction in PTV-ART compared to the non-adaptive PTV (R(2) = 0.94). CONCLUSION: Daily adaptive plan selection in RT of bladder cancer results in a considerable normal tissue sparing, of a magnitude that we expect will translate into a clinically significant reduction of the treatment-related morbidity.
Authors: Maria Antico; Peter Prinsen; Francesco Cellini; Alice Fracassi; Alfonso A Isola; David Cobben; Davide Fontanarosa Journal: PLoS One Date: 2019-02-28 Impact factor: 3.240
Authors: Robert A Huddart; Alison Birtle; Lauren Maynard; Mark Beresford; Jane Blazeby; Jenny Donovan; John D Kelly; Tony Kirkbank; Duncan B McLaren; Graham Mead; Clare Moynihan; Raj Persad; Christopher Scrase; Rebecca Lewis; Emma Hall Journal: BJU Int Date: 2017-05-29 Impact factor: 5.588
Authors: Shaista Hafeez; Fiona McDonald; Susan Lalondrelle; Helen McNair; Karole Warren-Oseni; Kelly Jones; Victoria Harris; Helen Taylor; Vincent Khoo; Karen Thomas; Vibeke Hansen; David Dearnaley; Alan Horwich; Robert Huddart Journal: Int J Radiat Oncol Biol Phys Date: 2017-02-09 Impact factor: 7.038
Authors: A Hunt; I Hanson; A Dunlop; H Barnes; L Bower; J Chick; C Cruickshank; E Hall; T Herbert; R Lawes; D McQuaid; H McNair; A Mitchell; J Mohajer; T Morgan; U Oelfke; G Smith; S Nill; R Huddart; S Hafeez Journal: Clin Transl Radiat Oncol Date: 2020-09-11