Kyle R Padgett1, Garrett Simpson2, David Asher3, Lorraine Portelance3, Elizabeth Bossart2, Nesrin Dogan2. 1. Department of Radiation Oncology, University of Miami, Miami, FL, USA; Department of Radiology, University of Miami, Miami, FL, USA; Department of Biomedical Engineering, University of Miami, Miami, FL, USA. Electronic address: kpadgett@med.miami.edu. 2. Department of Radiation Oncology, University of Miami, Miami, FL, USA; Department of Biomedical Engineering, University of Miami, Miami, FL, USA. 3. Department of Radiation Oncology, University of Miami, Miami, FL, USA.
Abstract
PURPOSE/ OBJECTIVE: Online Adaptive Radiotherapy (ART) with daily MR-imaging has the potential to improve dosimetric accuracy by accounting for inter-fractional anatomical changes. This study provides an assessment for the feasibility and potential benefits of online adaptive MRI-Guided Stereotactic Body Radiotherapy (SBRT) for treatment of liver cancer. MATERIALS/ METHODS: Ten patients with liver cancer treated with MR-Guided SBRT were included. Prescription doses ranged between 27 and 50 Gy in 3-5 fx. All SBRT fractions employed daily MR-guided setup while utilizing cine-MR gating. Organs-at-risk (OARs) included duodenum, bowel, stomach, kidneys and spinal cord. Daily MRIs and contours were utilized to create each adapted plan. Adapted plans used the beam-parameters and optimization-objectives from the initial plan. Planning target volume (PTV) coverage and OAR constraints were used to compare non-adaptive and adaptive plans. RESULTS: PTV coverage for non-adapted treatment plans was below the prescribed coverage for 32/47 fractions (68%), with 11 fractions failing by more than 10%. All 47 adapted fractions met prescribed coverage. OAR constraint violations were also compared for several organs. The duodenum exceeded tolerance for 5/23 non-adapted and 0/23 for adapted fractions. The bowel exceeded tolerance for 5/34 non-adaptive and 1/34 adaptive fractions. The stomach exceeded tolerance for 4/19 non-adapted and 1/19 for adaptive fractions. Accumulated dose volume histograms were also generated for each patient. CONCLUSION: Online adaptive MR-Guided SBRT of liver cancer using daily re-optimization resulted in better target conformality, coverage and OAR sparing compared with non-adaptive SBRT. Daily adaptive planning may allow for PTV dose escalation without compromising OAR sparing.
PURPOSE/ OBJECTIVE: Online Adaptive Radiotherapy (ART) with daily MR-imaging has the potential to improve dosimetric accuracy by accounting for inter-fractional anatomical changes. This study provides an assessment for the feasibility and potential benefits of online adaptive MRI-Guided Stereotactic Body Radiotherapy (SBRT) for treatment of liver cancer. MATERIALS/ METHODS: Ten patients with liver cancer treated with MR-Guided SBRT were included. Prescription doses ranged between 27 and 50 Gy in 3-5 fx. All SBRT fractions employed daily MR-guided setup while utilizing cine-MR gating. Organs-at-risk (OARs) included duodenum, bowel, stomach, kidneys and spinal cord. Daily MRIs and contours were utilized to create each adapted plan. Adapted plans used the beam-parameters and optimization-objectives from the initial plan. Planning target volume (PTV) coverage and OAR constraints were used to compare non-adaptive and adaptive plans. RESULTS:PTV coverage for non-adapted treatment plans was below the prescribed coverage for 32/47 fractions (68%), with 11 fractions failing by more than 10%. All 47 adapted fractions met prescribed coverage. OAR constraint violations were also compared for several organs. The duodenum exceeded tolerance for 5/23 non-adapted and 0/23 for adapted fractions. The bowel exceeded tolerance for 5/34 non-adaptive and 1/34 adaptive fractions. The stomach exceeded tolerance for 4/19 non-adapted and 1/19 for adaptive fractions. Accumulated dose volume histograms were also generated for each patient. CONCLUSION: Online adaptive MR-Guided SBRT of liver cancer using daily re-optimization resulted in better target conformality, coverage and OAR sparing compared with non-adaptive SBRT. Daily adaptive planning may allow for PTV dose escalation without compromising OAR sparing.
Authors: Paul Rogowski; Rieke von Bestenbostel; Franziska Walter; Katrin Straub; Lukas Nierer; Christopher Kurz; Guillaume Landry; Michael Reiner; Christoph Josef Auernhammer; Claus Belka; Maximilian Niyazi; Stefanie Corradini Journal: Cancers (Basel) Date: 2021-03-26 Impact factor: 6.639
Authors: Fabian Weykamp; Charlotte Herder-Wagner; Sebastian Regnery; Philipp Hoegen; C Katharina Renkamp; Jakob Liermann; Carolin Rippke; Stefan A Koerber; Laila König; Carolin Buchele; Sebastian Klüter; Jürgen Debus; Juliane Hörner-Rieber Journal: Strahlenther Onkol Date: 2021-09-01 Impact factor: 3.621
Authors: Evan Liang; Jennifer L Dolan; Eric D Morris; Jonathan Vono; Luisa F Bazan; Mei Lu; Carri K Glide-Hurst Journal: Adv Radiat Oncol Date: 2022-01-04