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Dosimetric benefit of MR-guided online adaptive radiotherapy in different tumor entities: liver, lung, abdominal lymph nodes, pancreas and prostate
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Dosimetric benefit of MR-guided online adaptive radiotherapy in different tumor entities: liver, lung, abdominal lymph nodes, pancreas and prostate
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Journal Article
Dosimetric benefit of MR-guided online adaptive radiotherapy in different tumor entities: liver, lung, abdominal lymph nodes, pancreas and prostate
2022
Overview
Background
Hybrid magnetic resonance (MR)-Linac systems have recently been introduced into clinical practice. The systems allow online adaption of the treatment plan with the aim of compensating for interfractional anatomical changes. The aim of this study was to evaluate the dose volume histogram (DVH)-based dosimetric benefits of online adaptive MR-guided radiotherapy (oMRgRT) across different tumor entities and to investigate which subgroup of plans improved the most from adaption.
Methods
Fifty patients treated with oMRgRT for five different tumor entities (liver, lung, multiple abdominal lymph nodes, pancreas, and prostate) were included in this retrospective analysis. Various target volume (gross tumor volume GTV, clinical target volume CTV, and planning target volume PTV) and organs at risk (OAR) related DVH parameters were compared between the dose distributions before and after plan adaption.
Results
All subgroups clearly benefited from online plan adaption in terms of improved PTV coverage. For the liver, lung and abdominal lymph nodes cases, a consistent improvement in GTV coverage was found, while many fractions of the prostate subgroup showed acceptable CTV coverage even before plan adaption. The largest median improvements in GTV near-minimum dose (D
98%
) were found for the liver (6.3%,
p
< 0.001), lung (3.9%,
p
< 0.001), and abdominal lymph nodes (6.8%,
p
< 0.001) subgroups. Regarding OAR sparing, the largest median OAR dose reduction during plan adaption was found for the pancreas subgroup (-87.0%). However, in the pancreas subgroup an optimal GTV coverage was not always achieved because sparing of OARs was prioritized.
Conclusion
With online plan adaptation, it was possible to achieve significant improvements in target volume coverage and OAR sparing for various tumor entities and account for interfractional anatomical changes.
Publisher
Springer Science and Business Media LLC,BioMed Central,BioMed Central Ltd,BMC
Subject
/ Biomedical and Life Sciences
/ Cancer
/ Female
/ Humans
/ Imaging
/ Liver Neoplasms - radiotherapy
/ Lung Neoplasms - radiotherapy
/ Lymphatic Metastasis - pathology
/ Lymphatic Metastasis - radiotherapy
/ Male
/ Medical physics. Medical radiology. Nuclear medicine
/ Methods
/ MRgOART
/ Neoplasms. Tumors. Oncology. Including cancer and carcinogens
/ Oncology
/ Online MRI guided radiotherapy
/ Pancreatic Neoplasms - pathology
/ Pancreatic Neoplasms - radiotherapy
/ Prostatic Neoplasms - pathology
/ Prostatic Neoplasms - radiotherapy
/ R895-920
