Towards rapid and efficient simulation-free radiotherapy: MR guided adaptive prostate radiotherapy on the MR-Linac using diagnostic MRI reference planning

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-07-19 DOI:10.1016/j.radonc.2025.111053

Joan Chick , Francis Casey , Sian Cooper , Trina Herbert , Sophie Alexander , Norina Predescu , Szabolcs-Botond Lőrincz-Molnár , Simeon Nill , Uwe Oelfke , Alison Tree , Alex Dunlop

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引用次数: 0

Abstract

Background and purpose

Simulation-free radiotherapy offers improved efficiency for adaptive treatments. This planning study presents a simulation-free pre-treatment workflow for prostate cancer online adaptive radiotherapy on a MR-Linac. Previously acquired diagnostic MR images are used to create a reference treatment plan without clinician input, and adapted plans are then simulated, and compared with those from the traditional workflow.

Materials and methods

All patients treated with 36.25 Gy in 5-fractions within the HERMES trial were retrospectively assessed for eligibility of simulation-free reference planning. If eligible, reference images were created from existing diagnostic MRI (T1w and T2w) to enable MR-only reference treatment planning. Target and OAR reference structures were autosegmented without clinician input. Online plan adaptation was simulated using existing clinical treatment images and structure sets. Adapted plans were compared with existing clinical plans, and synthetic CT accuracy assessed.

Results

87.5 % of patients had suitable diagnostic scans. Reference images and treatment plans were successfully created. Online treatment plans were simulated and were clinically acceptable for target dose and conformality, meeting all mandatory clinical goals with no detriment to OAR dose or plan deliverability. Accuracy of the synthetic CT approach was high with gamma results at 2mm/2% all above 98.9 %.

Conclusion

This study has shown that non radiotherapy-dedicated diagnostic MRI can be used for reference prostate planning on the MR-Linac, generating clinically equivalent adapted plans when compared to those originating from radiotherapy-simulation reference plans. This potentially saves multiple weeks in the pathway, improving radiotherapy efficiency and patient experience.

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快速有效的无模拟放疗：磁共振引导下的适应性前列腺放疗在MR- linac上使用诊断性MRI参考计划。

背景与目的：无模拟放射治疗提高了适应性治疗的效率。这项计划研究提出了一个在MR-Linac上进行前列腺癌在线自适应放疗的无模拟预处理工作流程。在没有临床医生输入的情况下，使用先前获得的诊断MR图像来创建参考治疗计划，然后将随后的适应计划与传统工作流程中的计划进行仿真比较。材料和方法：所有在HERMES试验中接受5份36.2 Gy治疗的患者回顾性评估无模拟参考计划的资格。如果符合条件，从现有的诊断性MRI （T1w和T2w）创建参考图像，以便仅使用MR参考治疗计划。目标和OAR参考结构在没有临床医生输入的情况下自动分割。利用现有的临床治疗图像和结构集模拟在线计划适应。比较现有临床方案，并评估合成CT的准确性。结果：87.5 %的患者有合适的诊断扫描。成功创建了参考图像和治疗计划。在线治疗计划是模拟的，临床可接受的目标剂量和一致性，满足所有强制性临床目标，不损害OAR剂量或计划可交付性。合成CT入路的准确度很高，伽玛结果为2 mm/2%，均高于98.9 %。结论：本研究表明，非放疗专用诊断MRI可用于MR-Linac上的参考前列腺规划，与源自放疗模拟参考计划的方案相比，可生成临床等效的适应方案。这可能会在通路中节省数周时间，提高放疗效率和患者体验。

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

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.