Cone Beam Computed Tomography-Based Online Adaptive Radiation Therapy of Esophageal Cancer: First Clinical Experience and Dosimetric Benefits

IF 2.2 Q3 ONCOLOGY Advances in Radiation Oncology Pub Date : 2024-10-22 DOI:10.1016/j.adro.2024.101656

Nicolas Bachmann MD , Daniel Schmidhalter BE , Frédéric Corminboeuf MD , Martin D. Berger MD , Yves Borbély MD , Ekin Ermiş MD , Emanuel Stutz MD , Binaya K. Shrestha MD , Daniel M. Aebersold MD , Peter Manser MD , Hossein Hemmatazad MD

{"title":"Cone Beam Computed Tomography-Based Online Adaptive Radiation Therapy of Esophageal Cancer: First Clinical Experience and Dosimetric Benefits","authors":"Nicolas Bachmann MD , Daniel Schmidhalter BE , Frédéric Corminboeuf MD , Martin D. Berger MD , Yves Borbély MD , Ekin Ermiş MD , Emanuel Stutz MD , Binaya K. Shrestha MD , Daniel M. Aebersold MD , Peter Manser MD , Hossein Hemmatazad MD","doi":"10.1016/j.adro.2024.101656","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation therapy (RT) plays a key role in the management of esophageal cancer (EC). However, toxicities caused by proximity of organs at risk (OAR) and daily target coverage caused by interfractional anatomic changes are of concern. Daily online adaptive RT (oART) addresses these concerns and has the potential to increase OAR sparing and improve target coverage. We present the first clinical experience and dosimetric investigations of cone beam CT-based oART in EC using the ETHOS platform.</div></div><div><h3>Methods and Materials</h3><div>Treatment fractions of the first 10 EC patients undergoing cone beam CT-based oART at our institution were retrospectively analyzed. The prescription dose was 50.4 Gy in 28 fractions. The same clinical target volume (CTV) and planning target volume (PTV) margins as for nonadaptive treatments were used. For all sessions, the timestamp of each oART workflow step, PTV size, target volume doses, mean heart dose, and lung V<sub>20Gy</sub> of both the scheduled and the adapted treatment plan were analyzed.</div></div><div><h3>Results</h3><div>Following automatic propagation, the CTV was adapted by the physician in 164 (59%) fractions. The adapted treatment plan was selected in 276 (99%) sessions. The median time needed for an oART session was 28 minutes (range, 14.8-43.3). Compared to the scheduled plans, a significant relative reduction of 9.5% in mean heart dose (absolute, 1.6 Gy; <em>P</em> = .006) and 16.9% reduction in mean lung V<sub>20Gy</sub> (absolute, 2.3%; <em>P</em> < .001) was achieved with the adapted treatment plans. Simultaneously, we observed a significant relative improvement in D99%PTV and D99%CTV by 15.3% (<em>P</em> < .001) and 5.0% (<em>P</em> = .008), respectively, along with a significant increase in D95%PTV by 5.1% (<em>P</em> = .003).</div></div><div><h3>Conclusions</h3><div>Although being resource-intensive, oART for EC is feasible in a reasonable timeframe and results in increased OAR sparing and improved target coverage, even without a reduction of margins. Further studies are planned to evaluate the potential clinical benefits.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101656"},"PeriodicalIF":2.2000,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Advances in Radiation Oncology","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2452109424002197","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

Radiation therapy (RT) plays a key role in the management of esophageal cancer (EC). However, toxicities caused by proximity of organs at risk (OAR) and daily target coverage caused by interfractional anatomic changes are of concern. Daily online adaptive RT (oART) addresses these concerns and has the potential to increase OAR sparing and improve target coverage. We present the first clinical experience and dosimetric investigations of cone beam CT-based oART in EC using the ETHOS platform.

Methods and Materials

Treatment fractions of the first 10 EC patients undergoing cone beam CT-based oART at our institution were retrospectively analyzed. The prescription dose was 50.4 Gy in 28 fractions. The same clinical target volume (CTV) and planning target volume (PTV) margins as for nonadaptive treatments were used. For all sessions, the timestamp of each oART workflow step, PTV size, target volume doses, mean heart dose, and lung V_20Gy of both the scheduled and the adapted treatment plan were analyzed.

Results

Following automatic propagation, the CTV was adapted by the physician in 164 (59%) fractions. The adapted treatment plan was selected in 276 (99%) sessions. The median time needed for an oART session was 28 minutes (range, 14.8-43.3). Compared to the scheduled plans, a significant relative reduction of 9.5% in mean heart dose (absolute, 1.6 Gy; P = .006) and 16.9% reduction in mean lung V_20Gy (absolute, 2.3%; P < .001) was achieved with the adapted treatment plans. Simultaneously, we observed a significant relative improvement in D99%PTV and D99%CTV by 15.3% (P < .001) and 5.0% (P = .008), respectively, along with a significant increase in D95%PTV by 5.1% (P = .003).

Conclusions

Although being resource-intensive, oART for EC is feasible in a reasonable timeframe and results in increased OAR sparing and improved target coverage, even without a reduction of margins. Further studies are planned to evaluate the potential clinical benefits.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

基于锥形束计算机断层扫描的食管癌在线自适应放射治疗：首次临床经验和剂量学优势

目的放射治疗（RT）在食管癌（EC）的治疗中发挥着关键作用。然而，由于邻近危险器官（OAR）而导致的毒性以及点间解剖学变化导致的每日靶点覆盖率令人担忧。每日在线自适应 RT（oART）可以解决这些问题，并有可能增加对危险器官的保护和提高靶点覆盖率。我们利用 ETHOS 平台介绍了基于锥形束 CT 的 OART 在 EC 中的首次临床经验和剂量学研究。方法和材料回顾性分析了我院首批接受基于锥形束 CT 的 OART 的 10 例 EC 患者的治疗分数。处方剂量为 50.4 Gy，共分 28 次。使用的临床靶体积（CTV）和计划靶体积（PTV）边缘与非适应性治疗相同。对所有疗程的每个 oART 工作流程步骤的时间戳、PTV 大小、靶体积剂量、平均心脏剂量以及计划治疗计划和适应性治疗计划的肺 V20Gy 进行了分析。在 276 次（99%）治疗中选择了调整后的治疗方案。一个 oART 疗程所需的中位时间为 28 分钟（14.8-43.3 分钟不等）。与预定计划相比，调整后的治疗计划使平均心脏剂量相对减少了 9.5%（绝对值为 1.6 Gy；P = .006），平均肺部 V20Gy 减少了 16.9%（绝对值为 2.3%；P < .001）。同时，我们观察到 D99%PTV 和 D99%CTV 的相对显著提高，分别为 15.3% (P < .001) 和 5.0% (P = .008)，D95%PTV 显著提高 5.1% (P = .003)。计划开展进一步研究，以评估其潜在的临床益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.