{"title":"Adapting outside the box: Simulation-free MR-guided stereotactic ablative radiotherapy for prostate cancer","authors":"","doi":"10.1016/j.radonc.2024.110527","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and purpose</h3><p>Magnetic resonance (MR)-guided radiotherapy (MRgRT) enhances treatment precision and adaptive capabilities, potentially supporting a simulation-free (sim-free) workflow. This work reports the first clinical implementation of a sim-free workflow using the MR-Linac for prostate cancer patients treated with stereotactic ablative radiotherapy (SABR).</p></div><div><h3>Materials and methods</h3><p>Fifteen patients who had undergone a prostate-specific membrane antigen positron emission tomography/CT (PSMA-PET/CT) scan as part of diagnostic workup were included in this work. Two reference plans were generated per patient: one using PSMA-PET/CT (sim-free plan) and the other using standard simulation CT (simCT plan). Dosimetric evaluations included comparisons between simCT, sim-free, and first fraction plans. Timing measurements were conducted to assess durations for both simCT and sim-free pre-treatment workflows.</p></div><div><h3>Results</h3><p>All 15 patients underwent successful treatment using a sim-free workflow. Dosimetric differences between simCT, sim-free, and first fraction plans were minor and within acceptable clinical limits, with no major violations of standardised criteria. The sim-free workflow took on average 130 min, while the simCT workflow took 103 min.</p></div><div><h3>Conclusion</h3><p>This work demonstrates the feasibility and benefits of sim-free MR-guided adaptive radiotherapy for prostate SABR, representing the first reported clinical experience in an ablative setting. By eliminating traditional simulation scans, this approach reduces patient burden by minimising hospital visits and enhances treatment accessibility.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9000,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167814024035059/pdfft?md5=aec6cfd6f46613eaf3f01ef7120b1d00&pid=1-s2.0-S0167814024035059-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiotherapy and Oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0167814024035059","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and purpose
Magnetic resonance (MR)-guided radiotherapy (MRgRT) enhances treatment precision and adaptive capabilities, potentially supporting a simulation-free (sim-free) workflow. This work reports the first clinical implementation of a sim-free workflow using the MR-Linac for prostate cancer patients treated with stereotactic ablative radiotherapy (SABR).
Materials and methods
Fifteen patients who had undergone a prostate-specific membrane antigen positron emission tomography/CT (PSMA-PET/CT) scan as part of diagnostic workup were included in this work. Two reference plans were generated per patient: one using PSMA-PET/CT (sim-free plan) and the other using standard simulation CT (simCT plan). Dosimetric evaluations included comparisons between simCT, sim-free, and first fraction plans. Timing measurements were conducted to assess durations for both simCT and sim-free pre-treatment workflows.
Results
All 15 patients underwent successful treatment using a sim-free workflow. Dosimetric differences between simCT, sim-free, and first fraction plans were minor and within acceptable clinical limits, with no major violations of standardised criteria. The sim-free workflow took on average 130 min, while the simCT workflow took 103 min.
Conclusion
This work demonstrates the feasibility and benefits of sim-free MR-guided adaptive radiotherapy for prostate SABR, representing the first reported clinical experience in an ablative setting. By eliminating traditional simulation scans, this approach reduces patient burden by minimising hospital visits and enhances treatment accessibility.
期刊介绍:
Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.