Dosimetric evaluation of cone beam computed tomography-guided online adaptive radiotherapy in gastric mucosa-associated lymphoid tissue lymphoma

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology Pub Date : 2025-06-25 DOI:10.1016/j.tipsro.2025.100321

Masanori Takaki , Taka-aki Hirose , Tadamasa Yoshitake , Keiji Matsumoto , Yuko Shirakawa , Hiroaki Wakiyama , Osamu Hisano , Hikaru Imafuku , Kousei Ishigami

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Abstract

Introduction

This study evaluated dosimetric values of cone beam computed tomography (CBCT)-guided online adaptive radiotherapy (oART) in patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma, accounting for interfractional and intrafractional motion.

Methods

Four patients with stage I gastric MALT lymphoma received CBCT-guided oART. For each of the 60 treatment sessions, scheduled (SCH) and adapted (ADP) plans were generated. Dosimetric evaluation focused on clinical target volume (CTV) and organs at risk (OARs). Metrics included CTV D98 % and D95 %, mean dose to the liver and left and right kidneys, maximum dose to the spinal cord, and V5Gy for bilateral kidneys. Adaptive planning CBCT-based contours were propagated to synthetic CTs of SCH and ADP plans to assess interfractional motion. Post-treatment CBCT-based contours were propagated to synthetic CTs of the ADP plan to evaluate intrafractional motion.

Results

ADP plans significantly improved CTV coverage: mean D98% increased from 94.7 % in the SCH plan to 98.6 %, and D95% from 97.3 % to 99.2 % (p < 0.001). Most OAR doses were reduced in the ADP plans, including bilateral kidney V5Gy (11.3 % vs. 8.3 %, p < 0.001) and spinal cord Dmax (9.8 Gy vs. 7.9 Gy, p < 0.001). Liver Dmean was slightly higher in the ADP plan (11.4 Gy vs. 11.1 Gy, p = 0.002). No significant differences were observed in CTV and OAR dosimetric parameters between adaptive planning and post-treatment CBCTs (e.g., CTV D98%: 98.6 % vs. 98.5 %, p = 0.629).

Conclusion

CBCT-guided oART improved target coverage and maintained post-treatment dosimetric stability in gastric MALT lymphoma, supporting clinical feasibility.

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锥形束计算机断层引导下在线适应放疗治疗胃黏膜相关淋巴组织淋巴瘤的剂量学评价

本研究评估了锥束计算机断层扫描（CBCT）引导下的在线适应性放疗（oART）在胃粘膜相关淋巴组织（MALT）淋巴瘤患者中的剂量学价值，考虑了分数间和分数内运动。方法4例I期胃MALT淋巴瘤患者行cbct引导下的oART治疗。对于60个疗程中的每一个，都生成了预定（SCH）和适应（ADP）计划。剂量学评价侧重于临床靶体积（CTV）和危险器官（OARs）。指标包括CTV d98%和d95%，肝脏和左右肾的平均剂量，脊髓的最大剂量，双侧肾脏的V5Gy。基于自适应规划cbct的轮廓被传播到SCH和ADP计划的合成ct中，以评估分数间运动。将治疗后基于cbct的轮廓传播到ADP计划的合成ct中，以评估术内运动。结果adp方案显著提高了CTV覆盖率：平均D98%由SCH方案的94.7%提高到98.6%，D95%由97.3%提高到99.2% (p <；0.001)。ADP方案中大多数OAR剂量减少，包括双侧肾V5Gy (11.3% vs. 8.3%, p <；0.001)和脊髓Dmax (9.8 Gy vs. 7.9 Gy, p <；0.001)。ADP组肝脏Dmean略高（11.4 Gy vs 11.1 Gy, p = 0.002）。适应性计划cbct和治疗后cbct的CTV和OAR剂量学参数无显著差异（例如，CTV D98%: 98.6% vs 98.5%, p = 0.629）。结论cbct引导下的oART提高了胃MALT淋巴瘤的靶标覆盖率，维持了治疗后剂量学的稳定性，支持临床可行性。

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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