Computed Tomography-Guided Online Adaptive Stereotactic Body Radiation Therapy for Liver Tumors: A Retrospective Study.

IF 6.4 1区医学 Q1 ONCOLOGY

International Journal of Radiation Oncology Biology Physics Pub Date : 2025-04-04 DOI:10.1016/j.ijrobp.2025.03.061

Alexander Lukez, Li Zhang, Eric M Horwitz, Thomas J Galloway, Mark A Hallman, Jessica K Wong, Sameera S Kumar, Rebecca M Shulman, Chang-Ming Charlie Ma, Ahmed Eldib, Joseph Panetta, Zachary Kiss, Robert H Freeman, Joshua E Meyer

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引用次数: 0

Abstract

Purpose: We present a computed tomography-guided online adaptive radiation therapy (CT-ART) experience in liver stereotactic body radiation therapy (SBRT).

Methods and materials: A retrospective registry study evaluated patients with hepatocellular carcinoma or liver metastasis treated with CT-ART. Physicians were offered 2 plans, the original plan transposed onto the cone beam CT with adapted contours and a new plan generated with updated contours. Treatment distance from planning target volume (PTV) to nearest organ at risk (OAR) was determined by calculating the distance from PTV to nearest OAR on cone beam CT for simulation and each fraction.

Results: Thirteen patients received SBRT 45 to 60 Gy (median, 50 Gy) in 5 fractions. Median PTV was 98.6 cc. Of 65 fractions, 77% (50) were adapted. Distance from PTV to nearest OAR over the course of treatment varied for 10 of 13 patients (range, 0-1.1 cm). Three patients without change in PTV-OAR distance all had PTV-OAR overlap at simulation. Despite having no PTV-OAR overlap at time of simulation, during treatment, 3 patients developed an overlap between PTV and nearest OAR. PTV V100% ≥ 95% criteria were met in 92% of adapted and 64% of scheduled plans (P = .042) and among fractions with PTV and OAR overlap, 87% of adapted and 33% of scheduled plans met PTV V100% goal (P = .045). For fractions with PTV-OAR overlap, maximum dose (Dmax) to nearest OAR was lower with adapted plan (P = .026). Adapted plans had lower mean stomach Dmax (P = .012) and lower mean duodenum Dmax (P = .05).

Conclusions: We demonstrate the distance between PTV and nearest OAR varies throughout a course of CT-ART SBRT for liver tumors. Overlap between the PTV and OAR during treatment emerged in half of patients with separation between 0.1 and 1.5 cm at time of simulation. Among fractions with PTV-OAR overlap, adapted plans improved ability to meet PTV V100% goal while reducing Dmax to nearest OAR.

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ct引导的肝肿瘤在线适应性立体定向放射治疗：回顾性研究。

目的：我们介绍了ct引导的在线适应性放射治疗（CT-ART）在肝脏立体定向放射治疗（SBRT）中的经验。方法：一项回顾性登记研究评估了接受CT-ART治疗的肝细胞癌或肝转移患者。医生被提供了两种方案，一种是将原始方案转换为具有适应轮廓的CBCT，另一种是由更新的轮廓生成的新方案。通过计算模拟CBCT上PTV到最近桨叶的距离和每个分数来确定PTV到最近桨叶的治疗距离。结果：13例患者分5次接受45 - 60 Gy（中位数：50 Gy）的SBRT治疗。中位PTV为98.6 cc。65个馏分中，77%（50个）适应。在治疗过程中，10/13例患者从PTV到最近桨部的距离各不相同（范围：0 - 1.1 cm）。3例PTV-OAR距离无变化的患者在模拟时均有PTV-OAR重叠。尽管在模拟时没有PTV-OAR重叠，但在治疗期间，有3例患者的PTV和最近的OAR重叠。92%的适应计划和64%的计划达到了PTV V100%≥95%的标准（p = 0.042），在PTV和OAR重叠的部分中，87%的适应计划和33%的计划达到了PTV V100%的目标（p = 0.045）。对于PTV-OAR重叠的分数，适应方案的Dmax到最近的OAR更低（p = 0.026）。适应方案胃Dmax平均值较低（p = 0.012），十二指肠Dmax平均值较低（p = 0.05）。结论：我们证明在肝肿瘤CT-ART SBRT治疗的整个过程中，PTV和最近的OAR之间的距离是不同的。一半的患者在治疗过程中出现PTV和OAR的重叠，在模拟时分离在0.1 - 1.5 cm之间。在PTV-OAR重叠的分数中，调整方案提高了PTV V100%目标的能力，同时将Dmax降低到最接近的OAR。

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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来源期刊

International Journal of Radiation Oncology Biology Physics 医学-核医学

CiteScore

11.00

自引率

7.10%

发文量

2538

审稿时长

6.6 weeks

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.