核磁共振成像引导的在线自适应放疗以及分区间和分区内运动对宫颈癌患者剂量学的影响

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology Pub Date : 2024-10-29 DOI:10.1016/j.ctro.2024.100881

Shouliang Ding , Zun Piao , Meining Chen , Fanghua Li , Yongbao Li , Biaoshui Liu , Hongdong Liu , Xiaoyan Huang , Junyun Li

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引用次数: 0

摘要

目的本研究旨在评估核磁共振成像引导的宫颈癌在线自适应放疗的分段间和分段内器官运动及剂量学优势。方法本研究共包括在 1.5 T Unity MR-Linac 上治疗的 150 个分段。每部分均获得治疗前、位置验证和治疗后的磁共振扫描。包括 CTV、直肠和膀胱在内的结构均由同一位放射肿瘤专家在每次核磁共振成像上划定。通过豪斯多夫距离（HD）、骰子相似系数（DSC）、相对体积差（ΔV）和几何中心的相对位置来评估分段间和分段内轮廓的变化。非ART计划和在线自适应计划分别通过重新计算或重新优化每日磁共振成像的参考计划获得。结果对于每个分区，CTV、膀胱和直肠的 HD、ΔV 和 DSC 的分区间变化都很显著。我们的研究还考察了膀胱和直肠充盈与 CTV 位置的关系。在 150 个非ART 计划中，45% 的计划未达到 CTV 覆盖限制（D98% ≥ 45 Gy），15% 的计划未达到规定剂量的 5%以上。与非 ART 方案相比，ART 方案的 CTV 覆盖率更高，膀胱和直肠的剂量更低（P < 0.05）。在治疗过程中，膀胱、直肠和 CTV 的点内变化可能会影响实际的剂量投放。我们观察到，CTV 的移动在分段内呈时间趋势。在后 MRI 中，有 15% 的分区由于分区内移动而未能达到 CTV 覆盖限制。结论在接受MR-Linac治疗的宫颈癌患者中观察到了明显的小区间和小区间CTV和OARs变化。MRI 引导的在线 ART 在宫颈癌治疗中具有显著的剂量学优势，是实现个体化精确放疗的理想方法。

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MRI guided online adaptive radiotherapy and the dosimetric impact of inter- and intrafractional motion in patients with cervical cancer

Purpose

The aim of this study was to evaluate the inter- and intrafractional organs motions and dosimetric advantages of MRI guided online adaptive radiotherapy for cervical cancer.

Methods

A total of 150 fractions treated on the 1.5 T Unity MR-Linac were included in this study. Each fraction, pre-treatment, position validation and post-treatment MRI scans were obtained. Structures including CTV, rectum and bladder were delineated by the same radiation oncologists on each MRI. The inter- and intrafractional changes of contours were assessed by Hausdorff distance (HD), dice similarity coefficient (DSC), relative volume difference (ΔV) and the relative positions of the geometric center. The non-ART plans and online adaptive plans were obtained by recalculating or re-optimizing from reference plans on daily MRI, respectively. CTV coverage and OARs constraints were evaluated between ART and non-ART plans.

Results

For each fraction, the interfractional changes of HD, ΔV and DSC for CTV, bladder and rectum were significant. Our study also examined the relationship of bladder and rectum filling on CTV position. For 150 non-ART plans, CTV coverage constraints (D_98% ≥ 45 Gy) were not met by 45 %, while 15 % were not covered by more than 5 % of the prescribed dose. Compared to the non-ART plans, the ART plans had higher CTV coverage and lower dose to the bladder and rectum (P < 0.05). During the treatment, the intrafractional changes of bladder, rectum and CTV may affect actual dose delivery. And we observed an intrafractional time trend in the motion of the CTV. There were 15 % fractions failing the CTV coverage constraints in post-MRI due to intrafractional motion. The adaptive plans optimized with 3 mm margin could cover CTV of post-MRI in 98 % fractions.

Conclusions

Considerable inter- and intrafractional CTV and OARs changes were observed in cervical cancer patients treated on MR-Linac. MRI guided online ART has significant dosimetric advantages in cervical cancer and is an ideal approach for achieving individualized and precise radiotherapy.

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来源期刊

Clinical and Translational Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

5.30

自引率

3.20%

发文量

114

审稿时长

40 days