Mathijs G Dassen, Ben Neijndorff, Anja Betgen, Lisa Wiersema, Peter de Ruiter, Joeke van der Linden, Tomas Janssen, Leontien Abbenhuis, Peter van Kollenburg, Casper Reijnen, Floris Pos, Robert J Smeenk, Uulke A van der Heide, Ellen Brunenberg
{"title":"模拟在线自适应磁共振成像引导的 SBRT 对精囊受累的局部晚期前列腺癌患者进行病灶增强。","authors":"Mathijs G Dassen, Ben Neijndorff, Anja Betgen, Lisa Wiersema, Peter de Ruiter, Joeke van der Linden, Tomas Janssen, Leontien Abbenhuis, Peter van Kollenburg, Casper Reijnen, Floris Pos, Robert J Smeenk, Uulke A van der Heide, Ellen Brunenberg","doi":"10.1016/j.prro.2024.10.009","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the feasibility and accuracy of focal boosting in online adaptive MRI-guided stereotactic body radiation therapy (SBRT) for patients with prostate cancer (PCa) with seminal vesicle invasion (T3b) by analyzing the impact of intrafraction motion on the dose planned for the gross tumor volume (GTV) and clinical target volume (CTV).</p><p><strong>Methods and materials: </strong>Data from 23 patients with T1-T3a PCa who received focal boosting SBRT on a 1.5T MR-Linac was used. A radiation oncologist replaced clinical GTVs with artificial GTVs representative for T3b tumor(s). For each MRI used for daily adaptation (MRI<sub>adapt</sub>), an automated treatment plan was generated (D<sub>f1-5</sub>) using the adapted contours. Patients were planned to receive 35 Gy to the CTV, with an isotoxic focal boost to the GTV up to 50 Gy. During each fraction, an additional MRI was acquired to assess intrafraction motion (MRI<sub>during</sub>). Dose accumulation of all fractions was performed by deformable registration of MRI<sub>adapt</sub>, <sub>f2-5</sub> to MRI<sub>adapt</sub>, <sub>f1</sub> (D<sub>ACC, planned</sub>)<sub>.</sub> The D<sub>f1</sub>-<sub>5</sub> were projected to their corresponding MRI<sub>during</sub>, which were used to reconstruct D<sub>ACC, delivered</sub>, likewise. Our results were compared to patients with tumor(s) without seminal vesicle invasion (T1-T3a).</p><p><strong>Results: </strong>The median (10th-90th percentile) D98%<sub>ACC, planned</sub> to the GTV, which correlates most strongly with outcome, was 41.1 Gy (40.1-43.0 Gy) in the plans for patients with artificial T3b tumors, compared to 43.0 Gy (40.4-47.2 Gy) in the plans for patients with T1-T3a tumors. The D98%<sub>ACC, delivered</sub> to the GTV, taking into account intrafraction motion, was 41.0 Gy (39.3-42.6 Gy) and 42.5 Gy (40.0-46.6 Gy) in the plans for the artificial and clinical GTVs, respectively.</p><p><strong>Conclusions: </strong>MRI-guidance can ensure high accuracy of focal boosting in patients with T3b disease. Because of the unfavorable location of the GTV, a lower boost dose was feasible compared to patients with T1-T3a PCa.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Simulation of Focal Boosting in Online Adaptive MRI-Guided SBRT for Patients With Locally Advanced Prostate Cancer With Seminal Vesicle Involvement.\",\"authors\":\"Mathijs G Dassen, Ben Neijndorff, Anja Betgen, Lisa Wiersema, Peter de Ruiter, Joeke van der Linden, Tomas Janssen, Leontien Abbenhuis, Peter van Kollenburg, Casper Reijnen, Floris Pos, Robert J Smeenk, Uulke A van der Heide, Ellen Brunenberg\",\"doi\":\"10.1016/j.prro.2024.10.009\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To evaluate the feasibility and accuracy of focal boosting in online adaptive MRI-guided stereotactic body radiation therapy (SBRT) for patients with prostate cancer (PCa) with seminal vesicle invasion (T3b) by analyzing the impact of intrafraction motion on the dose planned for the gross tumor volume (GTV) and clinical target volume (CTV).</p><p><strong>Methods and materials: </strong>Data from 23 patients with T1-T3a PCa who received focal boosting SBRT on a 1.5T MR-Linac was used. A radiation oncologist replaced clinical GTVs with artificial GTVs representative for T3b tumor(s). For each MRI used for daily adaptation (MRI<sub>adapt</sub>), an automated treatment plan was generated (D<sub>f1-5</sub>) using the adapted contours. Patients were planned to receive 35 Gy to the CTV, with an isotoxic focal boost to the GTV up to 50 Gy. During each fraction, an additional MRI was acquired to assess intrafraction motion (MRI<sub>during</sub>). Dose accumulation of all fractions was performed by deformable registration of MRI<sub>adapt</sub>, <sub>f2-5</sub> to MRI<sub>adapt</sub>, <sub>f1</sub> (D<sub>ACC, planned</sub>)<sub>.</sub> The D<sub>f1</sub>-<sub>5</sub> were projected to their corresponding MRI<sub>during</sub>, which were used to reconstruct D<sub>ACC, delivered</sub>, likewise. Our results were compared to patients with tumor(s) without seminal vesicle invasion (T1-T3a).</p><p><strong>Results: </strong>The median (10th-90th percentile) D98%<sub>ACC, planned</sub> to the GTV, which correlates most strongly with outcome, was 41.1 Gy (40.1-43.0 Gy) in the plans for patients with artificial T3b tumors, compared to 43.0 Gy (40.4-47.2 Gy) in the plans for patients with T1-T3a tumors. The D98%<sub>ACC, delivered</sub> to the GTV, taking into account intrafraction motion, was 41.0 Gy (39.3-42.6 Gy) and 42.5 Gy (40.0-46.6 Gy) in the plans for the artificial and clinical GTVs, respectively.</p><p><strong>Conclusions: </strong>MRI-guidance can ensure high accuracy of focal boosting in patients with T3b disease. Because of the unfavorable location of the GTV, a lower boost dose was feasible compared to patients with T1-T3a PCa.</p>\",\"PeriodicalId\":54245,\"journal\":{\"name\":\"Practical Radiation Oncology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2024-11-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Practical Radiation Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.prro.2024.10.009\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Practical Radiation Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.prro.2024.10.009","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
Simulation of Focal Boosting in Online Adaptive MRI-Guided SBRT for Patients With Locally Advanced Prostate Cancer With Seminal Vesicle Involvement.
Purpose: To evaluate the feasibility and accuracy of focal boosting in online adaptive MRI-guided stereotactic body radiation therapy (SBRT) for patients with prostate cancer (PCa) with seminal vesicle invasion (T3b) by analyzing the impact of intrafraction motion on the dose planned for the gross tumor volume (GTV) and clinical target volume (CTV).
Methods and materials: Data from 23 patients with T1-T3a PCa who received focal boosting SBRT on a 1.5T MR-Linac was used. A radiation oncologist replaced clinical GTVs with artificial GTVs representative for T3b tumor(s). For each MRI used for daily adaptation (MRIadapt), an automated treatment plan was generated (Df1-5) using the adapted contours. Patients were planned to receive 35 Gy to the CTV, with an isotoxic focal boost to the GTV up to 50 Gy. During each fraction, an additional MRI was acquired to assess intrafraction motion (MRIduring). Dose accumulation of all fractions was performed by deformable registration of MRIadapt, f2-5 to MRIadapt, f1 (DACC, planned). The Df1-5 were projected to their corresponding MRIduring, which were used to reconstruct DACC, delivered, likewise. Our results were compared to patients with tumor(s) without seminal vesicle invasion (T1-T3a).
Results: The median (10th-90th percentile) D98%ACC, planned to the GTV, which correlates most strongly with outcome, was 41.1 Gy (40.1-43.0 Gy) in the plans for patients with artificial T3b tumors, compared to 43.0 Gy (40.4-47.2 Gy) in the plans for patients with T1-T3a tumors. The D98%ACC, delivered to the GTV, taking into account intrafraction motion, was 41.0 Gy (39.3-42.6 Gy) and 42.5 Gy (40.0-46.6 Gy) in the plans for the artificial and clinical GTVs, respectively.
Conclusions: MRI-guidance can ensure high accuracy of focal boosting in patients with T3b disease. Because of the unfavorable location of the GTV, a lower boost dose was feasible compared to patients with T1-T3a PCa.
期刊介绍：
The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes:
Original articles focusing on patient safety, quality measurement, or quality improvement initiatives
Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues
ASTRO guidelines, position papers, and consensus statements
Essays that highlight enriching personal experiences in caring for cancer patients and their families.
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