Marguerite Tyran1, Naomi Jiang2, Minsong Cao3, Ann Raldow4, James M Lamb5, Daniel Low6, Elaine Luterstein7, Michael L Steinberg8, Percy Lee9. 1. Department of Radiation Oncology, University of California, Los Angeles, USA; Institut Paoli Calmettes, Marseille, France. Electronic address: MTyran@mednet.ucla.edu. 2. Department of Radiation Oncology, University of California, Los Angeles, USA. Electronic address: NJiang@mednet.ucla.edu. 3. Department of Radiation Oncology, University of California, Los Angeles, USA. Electronic address: MinsongCao@mednet.ucla.edu. 4. Department of Radiation Oncology, University of California, Los Angeles, USA. Electronic address: ARaldow@mednet.ucla.edu. 5. Department of Radiation Oncology, University of California, Los Angeles, USA. Electronic address: JLamb@mednet.ucla.edu. 6. David Geffen School of Medicine at UCLA, Los Angeles, USA. Electronic address: DLow@mednet.ucla.edu. 7. Department of Radiation Oncology, University of California, Los Angeles, USA. Electronic address: ELuterstein@mednet.ucla.edu. 8. Department of Radiation Oncology, University of California, Los Angeles, USA. Electronic address: MSteinberg@mednet.ucla.edu. 9. Department of Radiation Oncology, University of California, Los Angeles, USA; David Geffen School of Medicine at UCLA, Los Angeles, USA. Electronic address: PercyLee@mednet.ucla.edu.
Abstract
BACKGROUND/ PURPOSE: Stereotactic-magnetic-resonance-guided-online-adaptive-radiotherapy (SMART) is a promising tool for pancreas stereotactic-body-radiotherapy. Our online-adaptive-radiotherapy (On-ART) process relies on daily image overview by the managing radiation-oncologist, who determines the need for creating a predicted plan if significant interfractional anatomical changes are noted. Predicted plans are achieved through applying the baseline plan on deformed and manually adjusted contours based on daily imaging. If the dose to the target volume or organs-at-risk (OARs) violate constraints, an adapted plan is generated and delivered for treatment. In-depth review of daily images and deformed contours is limited by time and inter-observer variations. This study evaluates the reliability of our On-ART decision-making process. All fractions retrospectively underwent a predicted plan for off-line decision-making to adapt (Off-ART). Decisions to adapt were compared using On-ART and Off-ART approaches. MATERIAL/ METHODS: Thirty-five sets of daily images were analyzed from seven patients who underwent five fractions of SMART. Each OAR was fully re-contoured off-line by the same physician for each fraction. Off-ART decision was re-evaluated for each fraction. RESULTS: N = 14/35 fractions were adapted based on On-ART decision-making versus N = 25/35 with Off-ART. The concordance between On-ART and Off-ART decision was 87.5% for the 16 fractions using a predicted plan online and 42% for the 19 fractions using only visual image review for On-ART decision-making. CONCLUSIONS: Daily-image visual review is not reliable to determine benefit or not for adaptive radiation-therapy. Online predicted plan, based on deformed and manually adjusted contours, should be generated for every fraction that is delivered using SMART in order to reliably optimize treatment plans daily.
BACKGROUND/ PURPOSE: Stereotactic-magnetic-resonance-guided-online-adaptive-radiotherapy (SMART) is a promising tool for pancreas stereotactic-body-radiotherapy. Our online-adaptive-radiotherapy (On-ART) process relies on daily image overview by the managing radiation-oncologist, who determines the need for creating a predicted plan if significant interfractional anatomical changes are noted. Predicted plans are achieved through applying the baseline plan on deformed and manually adjusted contours based on daily imaging. If the dose to the target volume or organs-at-risk (OARs) violate constraints, an adapted plan is generated and delivered for treatment. In-depth review of daily images and deformed contours is limited by time and inter-observer variations. This study evaluates the reliability of our On-ART decision-making process. All fractions retrospectively underwent a predicted plan for off-line decision-making to adapt (Off-ART). Decisions to adapt were compared using On-ART and Off-ART approaches. MATERIAL/ METHODS: Thirty-five sets of daily images were analyzed from seven patients who underwent five fractions of SMART. Each OAR was fully re-contoured off-line by the same physician for each fraction. Off-ART decision was re-evaluated for each fraction. RESULTS: N = 14/35 fractions were adapted based on On-ART decision-making versus N = 25/35 with Off-ART. The concordance between On-ART and Off-ART decision was 87.5% for the 16 fractions using a predicted plan online and 42% for the 19 fractions using only visual image review for On-ART decision-making. CONCLUSIONS: Daily-image visual review is not reliable to determine benefit or not for adaptive radiation-therapy. Online predicted plan, based on deformed and manually adjusted contours, should be generated for every fraction that is delivered using SMART in order to reliably optimize treatment plans daily.
Authors: William A Hall; Eric S Paulson; Uulke A van der Heide; Clifton D Fuller; B W Raaymakers; Jan J W Lagendijk; X Allen Li; David A Jaffray; Laura A Dawson; Beth Erickson; Marcel Verheij; Kevin J Harrington; Arjun Sahgal; Percy Lee; Parag J Parikh; Michael F Bassetti; Clifford G Robinson; Bruce D Minsky; Ananya Choudhury; Robert J H A Tersteeg; Christopher J Schultz Journal: Eur J Cancer Date: 2019-10-12 Impact factor: 9.162
Authors: Carri K Glide-Hurst; Percy Lee; Adam D Yock; Jeffrey R Olsen; Minsong Cao; Farzan Siddiqui; William Parker; Anthony Doemer; Yi Rong; Amar U Kishan; Stanley H Benedict; X Allen Li; Beth A Erickson; Jason W Sohn; Ying Xiao; Evan Wuthrick Journal: Int J Radiat Oncol Biol Phys Date: 2020-10-24 Impact factor: 7.038
Authors: Elaine Luterstein; Minsong Cao; James M Lamb; Ann Raldow; Daniel Low; Michael L Steinberg; Percy Lee Journal: Adv Radiat Oncol Date: 2019-10-10