Clinical feasibility of treatment planning on a diagnostic CT scan without or with single fraction plan adaptation in patients with stage II/III rectal cancer

IF 4.9 1区医学 Q1 ONCOLOGY Radiotherapy and Oncology Pub Date : 2025-03-14 DOI:10.1016/j.radonc.2025.110840

Claudia S.E.W. Schuurhuizen , Maaike T.W. Milder, Judith H. Sluijter, Maarten L.P. Dirkx, Joost J.M.E. Nuyttens

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Abstract

Background

With the ultimate aim of reducing time to start radiotherapy treatment in patients with rectal cancer, this study explores the feasibility of omitting a planning CT scan (pCT), by utilizing the diagnostic CT scan (dCT) for treatment planning, with or without plan adaption using online adaptive radiotherapy.

Methods

Fifteen rectal cancer patients, with both dCT and pCT available, were included. Target volumes and organs at risk (OARs) were delineated on both scans, followed by treatment planning based on the dCT contours. Plans were recalculated on the pCT to assess dosimetric differences for target volumes and OARs. Additionally, five patients with HyperSight CBCT scans underwent a similar planning process. An online adaptive treatment workflow was simulated using the Ethos system, where the dCT and its plan served as the reference, and the HyperSight CBCT was used for adaptation.

Results

dCT-based plans showed adequate target volume coverage. However, when recalculated on the pCT, median coverage decreased for both CTV and PTV, and OAR doses increased. None of the 15 plans met prescribed constraints without online adaptive radiotherapy. In contrast, for all five patients in the adaptive workflow, the treatment plans met target volume coverage and OAR constraints.

Conclusion

Using dCT-based treatment planning is feasible for rectal cancer patients but requires at least one online adaptive session. A prospective trial (MEC 2023-0445) is ongoing in patients with rectal cancer, aiming to reduce time to start treatment, by omitting the pCT and using online adaptive radiotherapy workflow.

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背景为了缩短直肠癌患者开始放疗的时间，本研究探讨了利用诊断 CT 扫描（dCT）制定治疗计划，并使用在线自适应放疗调整或不调整计划，从而省略计划 CT 扫描（pCT）的可行性。两种扫描结果都划定了目标体积和危险器官（OAR），然后根据 dCT 轮廓制定治疗计划。在 pCT 上重新计算计划，以评估目标体积和 OAR 的剂量学差异。此外，五名接受 HyperSight CBCT 扫描的患者也接受了类似的规划流程。使用 Ethos 系统模拟了在线自适应治疗工作流程，其中 dCT 及其计划作为参考，HyperSight CBCT 用于自适应。然而，在 pCT 上重新计算时，CTV 和 PTV 的中位覆盖率下降，OAR 剂量增加。在没有在线自适应放疗的情况下，15 个计划中没有一个符合规定的限制条件。相比之下，在自适应工作流程中，所有五名患者的治疗计划都达到了目标容积覆盖率和OAR限制。目前正在对直肠癌患者进行一项前瞻性试验（MEC 2023-0445），旨在通过省略 pCT 和使用在线自适应放疗工作流程来缩短开始治疗的时间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.