Prescription dose and optimisation strategies in MR-guided online adaptive radiotherapy for kidney tumours: a two-step planning analysis.

IF 3.3 2区医学 Q2 ONCOLOGY

Radiation Oncology Pub Date : 2025-07-05 DOI:10.1186/s13014-025-02682-z

Takaya Yamamoto, Noriyoshi Takahashi, Shohei Tanaka, Rei Umezawa, Yu Suzuki, Keita Kishida, So Omata, Kazuya Takeda, Hinako Harada, Kiyokazu Sato, Noriyuki Kadoya, Keiichi Jingu

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Abstract

Background: Stereotactic radiotherapy (SRT) for kidney cancer, particularly when tumours are situated near critical organs-at-risk (OARs), presents significant challenges in achieving optimal dose delivery. MR-guided online adaptive radiotherapy (MRgoART) offers a promising solution by allowing real-time anatomical modification and plan reoptimisation. However, the ideal strategy for prescription dose selection and reoptimisation remains unclear.

Methods: This single-centre planning study evaluated kidney tumours located within 1 cm of gastrointestinal OARs. In Step 1, prescription doses for MRgoART were compared: the target dose (26 Gy) versus the planned dose (adjusted during pre-treatment planning to satisfy OAR constraints). In Step 2, two optimisation strategies were assessed: (1) covering 99% of the planning target volume (PTV) with the prescription dose (99%_xGy_Plan) and (2) delivering the full target dose with acceptable partial PTV coverage accepting dose heterogeneity (26Gy_x%_Plan), both respecting OAR constraints. Dose-volume parameters and blinded expert preferences were evaluated.

Results: Of 22 patients assessed, 14 patients with 18 tumours met the inclusion criteria. Among these, 36 MRgoART plans for 12 tumours were analysed in Step 1. Reoptimisation using the target dose resulted in significantly higher mean tumour doses, improved dose gradients, and PTV coverage metrics compared to reoptimisation based on the planned dose. In Step 2, 54 plans were assessed. Although the 26Gy_x%_Plan demonstrated superior mean tumour and PTV dose, it exhibited lower conformity. Radiation oncologists preferred the 26Gy_x%_Plan in 48% of cases, following 26% deemed almost equal, indicating its clinical advantage.

Conclusion: For kidney tumours adjacent to gastrointestinal OARs, MRgoART planning should favour reoptimisation based on the target dose. A high-dose strategy with partial PTV coverage (26Gy_x%_Plan) was generally preferred by radiation oncologists, balancing therapeutic effectiveness with OAR protection.

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处方剂量和优化策略在磁共振引导在线自适应放射治疗肾肿瘤：两步计划分析。

背景：立体定向放疗（SRT）用于肾癌，特别是当肿瘤位于关键危险器官（OARs）附近时，在实现最佳剂量递送方面提出了重大挑战。磁共振引导的在线自适应放疗（MRgoART）提供了一个有前途的解决方案，允许实时解剖修改和计划重新优化。然而，处方剂量选择和再优化的理想策略仍不清楚。方法：这项单中心计划研究评估了位于胃肠道桨管1厘米内的肾肿瘤。在步骤1中，比较MRgoART的处方剂量：目标剂量（26 Gy）与计划剂量（在治疗前计划中调整以满足OAR约束）。在步骤2中，评估了两种优化策略：(1)使用处方剂量（99% _xgy_plan）覆盖99%的计划目标体积（PTV），(2)提供可接受的部分PTV覆盖率（26Gy_x%_Plan）的全部目标剂量，均符合OAR约束。评估剂量-体积参数和盲法专家偏好。结果：22例患者中，14例患者18个肿瘤符合纳入标准。其中，在步骤1中分析了12个肿瘤的36个MRgoART计划。与基于计划剂量的再优化相比，使用目标剂量的再优化显著提高了平均肿瘤剂量，改善了剂量梯度和PTV覆盖指标。在步骤2中，评估了54个计划。虽然26Gy_x%_Plan显示了更高的平均肿瘤和PTV剂量，但其符合性较低。放射肿瘤学家在48%的病例中更喜欢26Gy_x%_Plan，其次26%的病例认为几乎相同，表明其临床优势。结论：对于胃肠道OARs附近的肾脏肿瘤，MRgoART计划应倾向于根据目标剂量重新优化。放射肿瘤学家通常选择具有部分PTV覆盖率（26Gy_x%_Plan）的高剂量策略，以平衡治疗效果和OAR保护。

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

Radiation Oncology ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

6.50

自引率

2.80%

发文量

181

审稿时长

3-6 weeks

期刊介绍： Radiation Oncology encompasses all aspects of research that impacts on the treatment of cancer using radiation. It publishes findings in molecular and cellular radiation biology, radiation physics, radiation technology, and clinical oncology.