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Title: Dosimetrically Triggered Adaptive Intensity Modulated Radiation Therapy for Cervical Cancer

Abstract

Purpose: The widespread use of intensity modulated radiation therapy (IMRT) for cervical cancer has been limited by internal target and normal tissue motion. Such motion increases the risk of underdosing the target, especially as planning margins are reduced in an effort to reduce toxicity. This study explored 2 adaptive strategies to mitigate this risk and proposes a new, automated method that minimizes replanning workload. Methods and Materials: Thirty patients with cervical cancer participated in a prospective clinical study and underwent pretreatment and weekly magnetic resonance (MR) scans over a 5-week course of daily external beam radiation therapy. Target volumes and organs at risk (OARs) were contoured on each of the scans. Deformable image registration was used to model the accumulated dose (the real dose delivered to the target and OARs) for 2 adaptive replanning scenarios that assumed a very small PTV margin of only 3 mm to account for setup and internal interfractional motion: (1) a preprogrammed, anatomy-driven midtreatment replan (A-IMRT); and (2) a dosimetry-triggered replan driven by target dose accumulation over time (D-IMRT). Results: Across all 30 patients, clinically relevant target dose thresholds failed for 8 patients (27%) if 3-mm margins were used without replanning. A-IMRT failed in only 3 patientsmore » and also yielded an additional small reduction in OAR doses at the cost of 30 replans. D-IMRT assured adequate target coverage in all patients, with only 23 replans in 16 patients. Conclusions: A novel, dosimetry-triggered adaptive IMRT strategy for patients with cervical cancer can minimize the risk of target underdosing in the setting of very small margins and substantial interfractional motion while minimizing programmatic workload and cost.« less

Authors:
 [1];  [2];  [3];  [2];  [3];  [2];  [4];  [2]; ;  [2];  [3]; ; ;  [5];  [2];  [3];  [3];  [3];  [3];  [2] more »;  [3] « less
  1. Department of Radiation Oncology, Liverpool Hospital, Sydney (Australia)
  2. Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario (Canada)
  3. (Canada)
  4. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)
  5. RaySearch Laboratories AB, Stockholm (Sweden)
Publication Date:
OSTI Identifier:
22420420
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 90; Journal Issue: 1; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ANATOMY; DOSIMETRY; EXTERNAL BEAM RADIATION THERAPY; HAZARDS; NEOPLASMS; NMR IMAGING; ORGANS; PATIENTS; PLANNING; RADIATION DOSES; TOXICITY

Citation Formats

Lim, Karen, Stewart, James, Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Kelly, Valerie, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Xie, Jason, Brock, Kristy K., Moseley, Joanne, Cho, Young-Bin, Fyles, Anthony, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Lundin, Anna, Rehbinder, Henrik, Löf, Johan, Jaffray, David A., Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Techna Institute for the Advancement of Technology for Health, Toronto, Ontario, Milosevic, Michael, E-mail: mike.milosevic@rmp.uhn.ca, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario. Dosimetrically Triggered Adaptive Intensity Modulated Radiation Therapy for Cervical Cancer. United States: N. p., 2014. Web. doi:10.1016/J.IJROBP.2014.05.039.
Lim, Karen, Stewart, James, Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Kelly, Valerie, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Xie, Jason, Brock, Kristy K., Moseley, Joanne, Cho, Young-Bin, Fyles, Anthony, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Lundin, Anna, Rehbinder, Henrik, Löf, Johan, Jaffray, David A., Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Techna Institute for the Advancement of Technology for Health, Toronto, Ontario, Milosevic, Michael, E-mail: mike.milosevic@rmp.uhn.ca, & Department of Radiation Oncology, University of Toronto, Toronto, Ontario. Dosimetrically Triggered Adaptive Intensity Modulated Radiation Therapy for Cervical Cancer. United States. doi:10.1016/J.IJROBP.2014.05.039.
Lim, Karen, Stewart, James, Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Kelly, Valerie, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Xie, Jason, Brock, Kristy K., Moseley, Joanne, Cho, Young-Bin, Fyles, Anthony, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Lundin, Anna, Rehbinder, Henrik, Löf, Johan, Jaffray, David A., Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Techna Institute for the Advancement of Technology for Health, Toronto, Ontario, Milosevic, Michael, E-mail: mike.milosevic@rmp.uhn.ca, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario. Mon . "Dosimetrically Triggered Adaptive Intensity Modulated Radiation Therapy for Cervical Cancer". United States. doi:10.1016/J.IJROBP.2014.05.039.
@article{osti_22420420,
title = {Dosimetrically Triggered Adaptive Intensity Modulated Radiation Therapy for Cervical Cancer},
author = {Lim, Karen and Stewart, James and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario and Kelly, Valerie and Department of Radiation Oncology, University of Toronto, Toronto, Ontario and Xie, Jason and Brock, Kristy K. and Moseley, Joanne and Cho, Young-Bin and Fyles, Anthony and Department of Radiation Oncology, University of Toronto, Toronto, Ontario and Lundin, Anna and Rehbinder, Henrik and Löf, Johan and Jaffray, David A. and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario and Department of Radiation Oncology, University of Toronto, Toronto, Ontario and Department of Medical Biophysics, University of Toronto, Toronto, Ontario and Techna Institute for the Advancement of Technology for Health, Toronto, Ontario and Milosevic, Michael, E-mail: mike.milosevic@rmp.uhn.ca and Department of Radiation Oncology, University of Toronto, Toronto, Ontario},
abstractNote = {Purpose: The widespread use of intensity modulated radiation therapy (IMRT) for cervical cancer has been limited by internal target and normal tissue motion. Such motion increases the risk of underdosing the target, especially as planning margins are reduced in an effort to reduce toxicity. This study explored 2 adaptive strategies to mitigate this risk and proposes a new, automated method that minimizes replanning workload. Methods and Materials: Thirty patients with cervical cancer participated in a prospective clinical study and underwent pretreatment and weekly magnetic resonance (MR) scans over a 5-week course of daily external beam radiation therapy. Target volumes and organs at risk (OARs) were contoured on each of the scans. Deformable image registration was used to model the accumulated dose (the real dose delivered to the target and OARs) for 2 adaptive replanning scenarios that assumed a very small PTV margin of only 3 mm to account for setup and internal interfractional motion: (1) a preprogrammed, anatomy-driven midtreatment replan (A-IMRT); and (2) a dosimetry-triggered replan driven by target dose accumulation over time (D-IMRT). Results: Across all 30 patients, clinically relevant target dose thresholds failed for 8 patients (27%) if 3-mm margins were used without replanning. A-IMRT failed in only 3 patients and also yielded an additional small reduction in OAR doses at the cost of 30 replans. D-IMRT assured adequate target coverage in all patients, with only 23 replans in 16 patients. Conclusions: A novel, dosimetry-triggered adaptive IMRT strategy for patients with cervical cancer can minimize the risk of target underdosing in the setting of very small margins and substantial interfractional motion while minimizing programmatic workload and cost.},
doi = {10.1016/J.IJROBP.2014.05.039},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 90,
place = {United States},
year = {Mon Sep 01 00:00:00 EDT 2014},
month = {Mon Sep 01 00:00:00 EDT 2014}
}