Simulation of Focal Boosting in Online Adaptive MRI-Guided SBRT for Patients With Locally Advanced Prostate Cancer With Seminal Vesicle Involvement.

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology Pub Date : 2024-11-06 DOI:10.1016/j.prro.2024.10.009

Mathijs G Dassen, Ben Neijndorff, Anja Betgen, Lisa Wiersema, Peter de Ruiter, Joeke van der Linden, Tomas Janssen, Leontien Abbenhuis, Peter van Kollenburg, Casper Reijnen, Floris Pos, Robert J Smeenk, Uulke A van der Heide, Ellen Brunenberg

{"title":"Simulation of Focal Boosting in Online Adaptive MRI-Guided SBRT for Patients With Locally Advanced Prostate Cancer With Seminal Vesicle Involvement.","authors":"Mathijs G Dassen, Ben Neijndorff, Anja Betgen, Lisa Wiersema, Peter de Ruiter, Joeke van der Linden, Tomas Janssen, Leontien Abbenhuis, Peter van Kollenburg, Casper Reijnen, Floris Pos, Robert J Smeenk, Uulke A van der Heide, Ellen Brunenberg","doi":"10.1016/j.prro.2024.10.009","DOIUrl":null,"url":null,"abstract":"Purpose: To evaluate the feasibility and accuracy of focal boosting in online adaptive MRI-guided stereotactic body radiation therapy (SBRT) for patients with prostate cancer (PCa) with seminal vesicle invasion (T3b) by analyzing the impact of intrafraction motion on the dose planned for the gross tumor volume (GTV) and clinical target volume (CTV).Methods and materials: Data from 23 patients with T1-T3a PCa who received focal boosting SBRT on a 1.5T MR-Linac was used. A radiation oncologist replaced clinical GTVs with artificial GTVs representative for T3b tumor(s). For each MRI used for daily adaptation (MRIadapt), an automated treatment plan was generated (Df1-5) using the adapted contours. Patients were planned to receive 35 Gy to the CTV, with an isotoxic focal boost to the GTV up to 50 Gy. During each fraction, an additional MRI was acquired to assess intrafraction motion (MRIduring). Dose accumulation of all fractions was performed by deformable registration of MRIadapt, f2-5 to MRIadapt, f1 (DACC, planned). The Df1-5 were projected to their corresponding MRIduring, which were used to reconstruct DACC, delivered, likewise. Our results were compared to patients with tumor(s) without seminal vesicle invasion (T1-T3a).Results: The median (10th-90th percentile) D98%ACC, planned to the GTV, which correlates most strongly with outcome, was 41.1 Gy (40.1-43.0 Gy) in the plans for patients with artificial T3b tumors, compared to 43.0 Gy (40.4-47.2 Gy) in the plans for patients with T1-T3a tumors. The D98%ACC, delivered to the GTV, taking into account intrafraction motion, was 41.0 Gy (39.3-42.6 Gy) and 42.5 Gy (40.0-46.6 Gy) in the plans for the artificial and clinical GTVs, respectively.Conclusions: MRI-guidance can ensure high accuracy of focal boosting in patients with T3b disease. Because of the unfavorable location of the GTV, a lower boost dose was feasible compared to patients with T1-T3a PCa.","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Practical Radiation Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.prro.2024.10.009","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: To evaluate the feasibility and accuracy of focal boosting in online adaptive MRI-guided stereotactic body radiation therapy (SBRT) for patients with prostate cancer (PCa) with seminal vesicle invasion (T3b) by analyzing the impact of intrafraction motion on the dose planned for the gross tumor volume (GTV) and clinical target volume (CTV).

Methods and materials: Data from 23 patients with T1-T3a PCa who received focal boosting SBRT on a 1.5T MR-Linac was used. A radiation oncologist replaced clinical GTVs with artificial GTVs representative for T3b tumor(s). For each MRI used for daily adaptation (MRI_adapt), an automated treatment plan was generated (D_f1-5) using the adapted contours. Patients were planned to receive 35 Gy to the CTV, with an isotoxic focal boost to the GTV up to 50 Gy. During each fraction, an additional MRI was acquired to assess intrafraction motion (MRI_during). Dose accumulation of all fractions was performed by deformable registration of MRI_adapt, _f2-5 to MRI_adapt, _f1 (D_{ACC, planned})_. The D_f1-₅ were projected to their corresponding MRI_during, which were used to reconstruct D_{ACC, delivered}, likewise. Our results were compared to patients with tumor(s) without seminal vesicle invasion (T1-T3a).

Results: The median (10th-90th percentile) D98%_{ACC, planned} to the GTV, which correlates most strongly with outcome, was 41.1 Gy (40.1-43.0 Gy) in the plans for patients with artificial T3b tumors, compared to 43.0 Gy (40.4-47.2 Gy) in the plans for patients with T1-T3a tumors. The D98%_{ACC, delivered} to the GTV, taking into account intrafraction motion, was 41.0 Gy (39.3-42.6 Gy) and 42.5 Gy (40.0-46.6 Gy) in the plans for the artificial and clinical GTVs, respectively.

Conclusions: MRI-guidance can ensure high accuracy of focal boosting in patients with T3b disease. Because of the unfavorable location of the GTV, a lower boost dose was feasible compared to patients with T1-T3a PCa.

查看原文本刊更多论文

模拟在线自适应磁共振成像引导的 SBRT 对精囊受累的局部晚期前列腺癌患者进行病灶增强。

目的：通过分析分次内运动对肿瘤总体积（GTV）和临床靶体积（CTV）计划剂量的影响，评估在线自适应 MRI 引导立体定向体放射治疗（SBRT）中对精囊受侵（T3b）前列腺癌（PCa）患者进行病灶增强治疗的可行性和准确性：材料和方法：使用23名T1-T3a PCa患者的数据，这些患者在1.5T MR-Linac上接受了局灶增量SBRT治疗。放射肿瘤学家用代表 T3b 肿瘤的人工 GTV 取代了临床 GTV。对于每个用于日常适应的 MRI（MRIadapt），都会使用适应的轮廓生成自动治疗计划（Df1-5）。患者计划在CTV接受35 Gy的治疗，在GTV接受等毒性病灶增强治疗，最高可达50 Gy。在每个分段期间，都会采集额外的磁共振成像来评估分段内的运动（MRIduring）。通过将 MRIadapt, f2-5 与 MRIadapt, f1（DACC，计划中）进行可变形配准，对所有分段进行剂量累积。Df1-5被投射到相应的MRIduring上，同样用于重建DACC, delivered。我们将结果与无精囊侵犯（T1-T3a）的肿瘤患者进行了比较：人工 T3b 肿瘤患者计划的 GTV D98%ACC 中位数（第 10-90 百分位数）与预后关系最大，为 41.1 Gy（40.1 - 43.0 Gy），而 T1-T3a 肿瘤患者计划的 GTV D98%ACC 中位数为 43.0 Gy（40.4 - 47.2 Gy）。考虑到分量内运动，人工GTV和临床GTV计划中投放到GTV的D98%ACC分别为41.0 Gy（39.3 - 42.6 Gy）和42.5 Gy（40.0 - 46.6 Gy）：结论：MRI引导可确保T3b疾病患者病灶增量的高准确性。由于GTV的位置不佳，与T1-T3a PCa患者相比，采用较低的增强剂量是可行的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Practical Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

5.20

自引率

6.10%

发文量

177

审稿时长

34 days

期刊介绍： The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes: Original articles focusing on patient safety, quality measurement, or quality improvement initiatives Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues ASTRO guidelines, position papers, and consensus statements Essays that highlight enriching personal experiences in caring for cancer patients and their families.