A simplified online adaptive workflow for long-course magnetic resonance-guided radiotherapy in esophageal cancer

IF 3.4 Q2 ONCOLOGY

Physics and Imaging in Radiation Oncology Pub Date : 2025-01-01 DOI:10.1016/j.phro.2025.100717

Koen M. Kuijer, Roel Bouwmans, Lando S. Bosma, Stella Mook , Gert J. Meijer

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引用次数: 0

Abstract

Background and Purpose

Online adaptive magnetic resonance-guided radiotherapy (MRgRT) enables high-precision radiotherapy for esophageal cancer patients but is less feasible due to long on-table times in combination with long-course treatment. In this study, we conducted an in-silico assessment of a simplified online adaptive workflow, Adapt-To-Shape-lite (ATS-lite), in which deformable propagated contours are not modified, and assessed its feasibility.

Materials and Methods

The ATS-lite workflow was simulated for all fractions of nine esophageal cancer patients who had previously received full online adaptive MRgRT with manual contour corrections if needed. The deformable propagated contours were not adjusted. A dose of 41.4 Gy in 23 fractions was prescribed. Intra- and interfraction dose accumulation were performed to evaluate target coverage per fraction and across the entire treatment. For individual fractions, coverage of the manually corrected clinical target volume (CTV) was considered adequate if V95% > 98 % and V90% > 99.5 %. Feasibility was assessed by recording treatment times in the first patients treated with ATS-lite.

Results

The ATS-lite workflow provided adequate target coverage over the entire treatment for all patients, with sufficient coverage in 90% of the 177 fractions analyzed. Closer inspection revealed that inadequate target coverage in individual fractions was primarily attributed to enlargement of the manually corrected CTV, rather than poor contour propagation in the ATS-lite workflow. In seven patients, the ATS-lite workflow achieved a median time per fraction of 23 min.

Conclusions

The ATS-lite workflow provides adequate target coverage and is feasible for online adaptive MRgRT in long-course esophageal cancer treatments.

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一种用于食管癌长疗程磁共振引导放疗的简化在线自适应工作流程

背景与目的在线自适应磁共振引导放疗（MRgRT）为食管癌患者提供了高精度放疗，但由于手术时间长且疗程长，因此不太可行。在这项研究中，我们对一种简化的在线自适应工作流程进行了计算机评估，即不修改可变形传播轮廓的ATS-lite，并评估了其可行性。材料和方法对9名食管癌患者的所有部分进行ats - life工作流程模拟，这些患者先前接受了完整的在线自适应MRgRT，如果需要，还进行了人工轮廓校正。未调整可变形的传播轮廓。给药剂量为41.4 Gy，分为23份。在整个治疗过程中，进行了内剂量累积和间剂量累积，以评估每个分数的目标覆盖率。对于单个分数，手动校正临床靶体积（CTV）的覆盖率被认为足够，如果V95% >；98%和V90% >；99.5%。通过记录第一批接受ats - life治疗的患者的治疗时间来评估可行性。结果ats - life工作流程在所有患者的整个治疗过程中提供了足够的目标覆盖率，在所分析的177个分数中有90%具有足够的覆盖率。仔细检查发现，单个分数的目标覆盖率不足主要归因于人工校正的CTV的扩大，而不是ats - life工作流程中的轮廓传播不良。在7例患者中，ats - life工作流程的平均时间为23分钟。结论ats - life工作流程提供了足够的目标覆盖，并且在长期食管癌治疗的在线适应性MRgRT中是可行的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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