Alexander Lukez, Li Zhang, Eric M Horwitz, Thomas J Galloway, Mark A Hallman, Jessica K Wong, Sameera S Kumar, Rebecca M Shulman, Chang-Ming Charlie Ma, Ahmed Eldib, Joseph Panetta, Zachary Kiss, Robert H Freeman, Joshua E Meyer
{"title":"ct引导的肝肿瘤在线适应性立体定向放射治疗：回顾性研究。","authors":"Alexander Lukez, Li Zhang, Eric M Horwitz, Thomas J Galloway, Mark A Hallman, Jessica K Wong, Sameera S Kumar, Rebecca M Shulman, Chang-Ming Charlie Ma, Ahmed Eldib, Joseph Panetta, Zachary Kiss, Robert H Freeman, Joshua E Meyer","doi":"10.1016/j.ijrobp.2025.03.061","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>We present a computed tomography-guided online adaptive radiation therapy (CT-ART) experience in liver stereotactic body radiation therapy (SBRT).</p><p><strong>Methods and materials: </strong>A retrospective registry study evaluated patients with hepatocellular carcinoma or liver metastasis treated with CT-ART. Physicians were offered 2 plans, the original plan transposed onto the cone beam CT with adapted contours and a new plan generated with updated contours. Treatment distance from planning target volume (PTV) to nearest organ at risk (OAR) was determined by calculating the distance from PTV to nearest OAR on cone beam CT for simulation and each fraction.</p><p><strong>Results: </strong>Thirteen patients received SBRT 45 to 60 Gy (median, 50 Gy) in 5 fractions. Median PTV was 98.6 cc. Of 65 fractions, 77% (50) were adapted. Distance from PTV to nearest OAR over the course of treatment varied for 10 of 13 patients (range, 0-1.1 cm). Three patients without change in PTV-OAR distance all had PTV-OAR overlap at simulation. Despite having no PTV-OAR overlap at time of simulation, during treatment, 3 patients developed an overlap between PTV and nearest OAR. PTV V100% ≥ 95% criteria were met in 92% of adapted and 64% of scheduled plans (P = .042) and among fractions with PTV and OAR overlap, 87% of adapted and 33% of scheduled plans met PTV V100% goal (P = .045). For fractions with PTV-OAR overlap, maximum dose (Dmax) to nearest OAR was lower with adapted plan (P = .026). Adapted plans had lower mean stomach Dmax (P = .012) and lower mean duodenum Dmax (P = .05).</p><p><strong>Conclusions: </strong>We demonstrate the distance between PTV and nearest OAR varies throughout a course of CT-ART SBRT for liver tumors. Overlap between the PTV and OAR during treatment emerged in half of patients with separation between 0.1 and 1.5 cm at time of simulation. Among fractions with PTV-OAR overlap, adapted plans improved ability to meet PTV V100% goal while reducing Dmax to nearest OAR.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4000,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Computed Tomography-Guided Online Adaptive Stereotactic Body Radiation Therapy for Liver Tumors: A Retrospective Study.\",\"authors\":\"Alexander Lukez, Li Zhang, Eric M Horwitz, Thomas J Galloway, Mark A Hallman, Jessica K Wong, Sameera S Kumar, Rebecca M Shulman, Chang-Ming Charlie Ma, Ahmed Eldib, Joseph Panetta, Zachary Kiss, Robert H Freeman, Joshua E Meyer\",\"doi\":\"10.1016/j.ijrobp.2025.03.061\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>We present a computed tomography-guided online adaptive radiation therapy (CT-ART) experience in liver stereotactic body radiation therapy (SBRT).</p><p><strong>Methods and materials: </strong>A retrospective registry study evaluated patients with hepatocellular carcinoma or liver metastasis treated with CT-ART. Physicians were offered 2 plans, the original plan transposed onto the cone beam CT with adapted contours and a new plan generated with updated contours. Treatment distance from planning target volume (PTV) to nearest organ at risk (OAR) was determined by calculating the distance from PTV to nearest OAR on cone beam CT for simulation and each fraction.</p><p><strong>Results: </strong>Thirteen patients received SBRT 45 to 60 Gy (median, 50 Gy) in 5 fractions. Median PTV was 98.6 cc. Of 65 fractions, 77% (50) were adapted. Distance from PTV to nearest OAR over the course of treatment varied for 10 of 13 patients (range, 0-1.1 cm). Three patients without change in PTV-OAR distance all had PTV-OAR overlap at simulation. Despite having no PTV-OAR overlap at time of simulation, during treatment, 3 patients developed an overlap between PTV and nearest OAR. PTV V100% ≥ 95% criteria were met in 92% of adapted and 64% of scheduled plans (P = .042) and among fractions with PTV and OAR overlap, 87% of adapted and 33% of scheduled plans met PTV V100% goal (P = .045). For fractions with PTV-OAR overlap, maximum dose (Dmax) to nearest OAR was lower with adapted plan (P = .026). Adapted plans had lower mean stomach Dmax (P = .012) and lower mean duodenum Dmax (P = .05).</p><p><strong>Conclusions: </strong>We demonstrate the distance between PTV and nearest OAR varies throughout a course of CT-ART SBRT for liver tumors. Overlap between the PTV and OAR during treatment emerged in half of patients with separation between 0.1 and 1.5 cm at time of simulation. Among fractions with PTV-OAR overlap, adapted plans improved ability to meet PTV V100% goal while reducing Dmax to nearest OAR.</p>\",\"PeriodicalId\":14215,\"journal\":{\"name\":\"International Journal of Radiation Oncology Biology Physics\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":6.4000,\"publicationDate\":\"2025-04-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Radiation Oncology Biology Physics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ijrobp.2025.03.061\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Radiation Oncology Biology Physics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ijrobp.2025.03.061","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
Computed Tomography-Guided Online Adaptive Stereotactic Body Radiation Therapy for Liver Tumors: A Retrospective Study.
Purpose: We present a computed tomography-guided online adaptive radiation therapy (CT-ART) experience in liver stereotactic body radiation therapy (SBRT).
Methods and materials: A retrospective registry study evaluated patients with hepatocellular carcinoma or liver metastasis treated with CT-ART. Physicians were offered 2 plans, the original plan transposed onto the cone beam CT with adapted contours and a new plan generated with updated contours. Treatment distance from planning target volume (PTV) to nearest organ at risk (OAR) was determined by calculating the distance from PTV to nearest OAR on cone beam CT for simulation and each fraction.
Results: Thirteen patients received SBRT 45 to 60 Gy (median, 50 Gy) in 5 fractions. Median PTV was 98.6 cc. Of 65 fractions, 77% (50) were adapted. Distance from PTV to nearest OAR over the course of treatment varied for 10 of 13 patients (range, 0-1.1 cm). Three patients without change in PTV-OAR distance all had PTV-OAR overlap at simulation. Despite having no PTV-OAR overlap at time of simulation, during treatment, 3 patients developed an overlap between PTV and nearest OAR. PTV V100% ≥ 95% criteria were met in 92% of adapted and 64% of scheduled plans (P = .042) and among fractions with PTV and OAR overlap, 87% of adapted and 33% of scheduled plans met PTV V100% goal (P = .045). For fractions with PTV-OAR overlap, maximum dose (Dmax) to nearest OAR was lower with adapted plan (P = .026). Adapted plans had lower mean stomach Dmax (P = .012) and lower mean duodenum Dmax (P = .05).
Conclusions: We demonstrate the distance between PTV and nearest OAR varies throughout a course of CT-ART SBRT for liver tumors. Overlap between the PTV and OAR during treatment emerged in half of patients with separation between 0.1 and 1.5 cm at time of simulation. Among fractions with PTV-OAR overlap, adapted plans improved ability to meet PTV V100% goal while reducing Dmax to nearest OAR.
期刊介绍：
International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field.
This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.
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