Comparison of different dose accumulation strategies to estimate organ doses after stereotactic magnetic resonance-guided adaptive radiotherapy

Bibliographic Details
Title:	Comparison of different dose accumulation strategies to estimate organ doses after stereotactic magnetic resonance-guided adaptive radiotherapy
Authors:	Sebastian Regnery, Lukas Leiner, Carolin Buchele, Philipp Hoegen, Elisabetta Sandrini, Thomas Held, Maximilian Deng, Tanja Eichkorn, Carolin Rippke, C. Katharina Renkamp, Laila König, Kristin Lang, Sebastian Adeberg, Jürgen Debus, Sebastian Klüter, Juliane Hörner-Rieber
Source:	Radiation Oncology, Vol 18, Iss 1, Pp 1-12 (2023)
Publisher Information:	BMC, 2023.
Publication Year:	2023
Collection:	LCC:Medical physics. Medical radiology. Nuclear medicine LCC:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Subject Terms:	Stereotactic body Radiotherapy (SABR), Image-guided Radiotherapy (IGRT), MR-guided adaptive radiotherapy, Pulmonary Cancer, Liver Cancer, Deformable image Registration, Medical physics. Medical radiology. Nuclear medicine, R895-920, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
More Details:	Abstract Introduction Re-irradiation is frequently performed in the era of precision oncology, but previous doses to organs-at-risk (OAR) must be assessed to avoid cumulative overdoses. Stereotactic magnetic resonance-guided online adaptive radiotherapy (SMART) enables highly precise ablation of tumors close to OAR. However, OAR doses may change considerably during adaptive treatment, which complicates potential re-irradiation. We aimed to compare the baseline plan with different dose accumulation techniques to inform re-irradiation. Patients & methods We analyzed 18 patients who received SMART to lung or liver tumors inside prospective databases. Cumulative doses were calculated inside the planning target volumes (PTV) and OAR for the adapted plans and theoretical non-adapted plans via (1) cumulative dose volume histograms (DVH sum plan) and (2) deformable image registration (DIR)-based dose accumulation to planning images (DIR sum plan). We compared cumulative dose parameters between the baseline plan, DVH sum plan and DIR sum plan using equivalent doses in 2 Gy fractions (EQD2). Results Individual patients presented relevant increases of near-maximum doses inside the proximal bronchial tree, spinal cord, heart and gastrointestinal OAR when comparing adaptive treatment to the baseline plans. The spinal cord near-maximum doses were significantly increased in the liver patients (D2% median: baseline 6.1 Gy, DIR sum 8.1 Gy, DVH sum 8.4 Gy, p = 0.04; D0.1 cm³ median: baseline 6.1 Gy, DIR sum 8.1 Gy, DVH sum 8.5 Gy, p = 0.04). Three OAR overdoses occurred during adaptive treatment (DIR sum: 1, DVH sum: 2), and four more intense OAR overdoses would have occurred during non-adaptive treatment (DIR sum: 4, DVH sum: 3). Adaptive treatment maintained similar PTV coverages to the baseline plans, while non-adaptive treatment yielded significantly worse PTV coverages in the lung (D95% median: baseline 86.4 Gy, DIR sum 82.4 Gy, DVH sum 82.2 Gy, p = 0.006) and liver patients (D95% median: baseline 87.4 Gy, DIR sum 82.1 Gy, DVH sum 81.1 Gy, p = 0.04). Conclusion OAR doses can increase during SMART, so that re-irradiation should be planned based on dose accumulations of the adapted plans instead of the baseline plan. Cumulative dose volume histograms represent a simple and conservative dose accumulation strategy.
Document Type:	article
File Description:	electronic resource
Language:	English
ISSN:	1748-717X
Relation:	https://doaj.org/toc/1748-717X
DOI:	10.1186/s13014-023-02284-7
Access URL:	https://doaj.org/article/e82ce75062ad403e92ccd6418c50a3eb
Accession Number:	edsdoj.82ce75062ad403e92ccd6418c50a3eb
Database:	Directory of Open Access Journals
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More Details
ISSN:	1748717X
DOI:	10.1186/s13014-023-02284-7
Published in:	Radiation Oncology
Language:	English