A Prospective Single-Arm Study of Daily Online Adaptive Radiation Therapy for Cervical Cancer with Reduced Planning Target Volume Margin: Acute Toxicity and Dosimetric Outcomes.
Guangyu Wang, Yining Chen, Zhiqun Wang, Zheng Zeng, Yuliang Sun, Bing Zhou, Bo Yang, Jie Qiu, Junfang Yan, Ke Hu, Fuquan Zhang
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引用次数: 0
Abstract
Purpose: To evaluate acute toxicity and dosimetric outcomes in cervical cancer treated with daily iterative cone beam computed tomography (iCBCT) guided online adaptive radiation therapy (oART) using reduced planning target volume (PTV) margin.
Methods and materials: From February 2023 to November 2023, 27 patients with stages I to III cervical cancer were prospectively enrolled in this study. All patients received daily iCBCT guided oART (prescribed 50.4 Gy in 28 fractions) with concurrent weekly chemotherapy followed by brachytherapy. A uniform 10-mm margin was used to cover more variable uterus (PTV-U), and 5-mm margin was used for other PTV. The dosimetric results for each oART fraction were recorded. Both clinician- and patient-reported acute toxicities were assessed before treatment, weekly during treatment, 1 month and 3 months after treatment.
Results: The average total treatment time was 22 minutes and 54 seconds, and the adapted plan was selected for all fractions. The adapted plans showed superior coverage for the target volume and dosimetric improvement of organs at risk compared with the scheduled plan. Overall, no patient had grade ≥ 4 acute toxicities. Grades 1, 2, and 3 acute gastrointestinal toxicity were 26%, 19%, and 4%, respectively, among which diarrhea was the most common. Only grade 1 acute genitourinary toxicity was observed in 2 cases (7%). The low incidence of acute toxicity was supported by patient-reported outcome data, which showed significant decreases in mean standard scores on function subscales and significant increases on symptom subscales/items following the initiation of oART. Most of these scales returned to baseline average scores by the 1-month follow-up.
Conclusions: This prospective study of daily oART in patients with cervical cancer observed dosimetric benefits and a low incidence of acute toxicity, both in clinician- and patient-reported outcome measurements.
期刊介绍：
International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field.
This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.
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