Adaptive Liver Stereotactic Body Radiation Therapy: Automated Daily Plan Reoptimization Prevents Dose Delivery Degradation Caused by Anatomy Deformations

Leinders, S.M.; Breedveld, S.; Romero, Alejandra Méndez; Schaart, Dennis R.; Seppenwoolde, Yvette; Heijmen, B.

doi:10.1016/j.ijrobp.2013.08.009

Cited by 21 publications

(16 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Leinders et al [27] recently piloted daily adaptive IMRT re-optimization for liver SBRT. In 2 of 12 GTVs the intervention permitted better PTV dose coverage, but dose-escalation beyond the initial prescription was not investigated.…”

Section: Discussionmentioning

confidence: 99%

Dose Escalated Liver Stereotactic Body Radiation Therapy at the Mean Respiratory Position

Velec¹,

Moseley²,

Dawson³

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

Purpose The dosimetric impact of dose-probability based PTV margins for liver cancer patients receiving SBRT was compared to standard PTV based on the internal target volume (ITV). Plan robustness was evaluated by accumulating the treatment dose to ensure delivery of the intended plan. Methods and Materials Twenty patients planned on exhale CT for 27–50 Gy in 6 fractions using an ITV-based PTV and treated free-breathing were retrospectively evaluated. Iso-toxic, dose-escalated plans were created on mid-position CT, representing the mean breathing position, using a dose-probability PTV. The delivered doses were accumulated using biomechanical deformable registration of the daily cone-beam CT based on liver targeting at the exhale or mean breathing position, for the exhale and mid-position CT plans respectively. Results The dose-probability PTVs were on average 38% smaller than the ITV-based PTV enabling an average±standard deviation increase in the planned dose to 95% of the PTV of 4.0±2.8 Gy (9±5%) on the mid-position CT (p<0.01). For both plans, the delivered minimum GTV doses were greater than the planned nominal prescribed dose in all 20 patients and greater than the planned dose to 95% of the PTV in 18 (90%) patients. Nine patients (45%) had one or more GTVs with a delivered minimum dose more than 5 Gy higher with the mid-position CT plan using dose-probability PTV, compared to the delivered dose with the exhale CT plan using ITV-based PTV. Conclusions For iso-toxic liver SBRT planned and delivered at the mean respiratory, reduced dose-probability PTV enables a mean escalation of 4 Gy (9%) in 6 fractions over ITV-based PTV. This may potentially improve local control without increasing the risk of tumor under-dosing.

show abstract

Section: Discussionmentioning

confidence: 99%

Dose Escalated Liver Stereotactic Body Radiation Therapy at the Mean Respiratory Position

Velec¹,

Moseley²,

Dawson³

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

show abstract

“…Adaptive radiotherapy (ART) to cope with anatomy deformations, particle therapy for reduction of OAR dose delivery and management of intrafraction motion are sophisticated novel technologies attracting most attention. ART has shown advantages for liver SABR in a simulation study, 8 and particle therapy has been investigated for limited numbers of patients. 9 Tomosynthesis is a promising technique where 3D images can be reconstructed over a limited range of acquisition angles ( i.e.…”

Section: Commentarymentioning

confidence: 99%

The role of technology in clinical trials using stereotactic body radiotherapy

Aznar

Romero

Heijmen

2017

The British Journal of Radiology

View full text Add to dashboard Cite

Stereotactic body radiotherapy is a highly technology-driven treatment modality. The wider availability of in-room imaging and advanced radiotherapy delivery techniques has led to more institutions offering stereotactic ablative therapy (SABR). While some technological challenges remain, the crucial point for the next generation of SABR clinical trials is that today's technology is used correctly and close to its optimal potential for accuracy. The credentialing procedure of SABR needs to be extensive, but this investment will benefit the trial itself, the patients and the professionals involved.

show abstract

“…A clinical study of liver SBRT delivered with online MR guidance and gating under free breathing noted local failures possibly due to compromised target coverage adjacent to dose‐limiting normal organs 2 . Online adaptive replanning for liver and pancreas SBRT may be required to enable isotoxic dose escalation to account for deformation within normal tissues and position within the abdomen 15–17 . The impact of abdominal compression on normal tissue deformations is less clear in comparison to its impact on breathing motion.…”

Section: Introductionmentioning

confidence: 99%

MRI evaluation of normal tissue deformation and breathing motion under an abdominal compression device

Lee

Simeonov

Stanescu

et al. 2021

J Applied Clin Med Phys

View full text Add to dashboard Cite

Purpose Abdominal compression can minimize breathing motion in stereotactic radiotherapy, though it may impact the positioning of dose‐limiting normal tissues. This study quantified the reproducibility of abdominal normal tissues and respiratory motion with the use of an abdominal compression device using MR imaging. Methods Twenty healthy volunteers had repeat MR over 3 days under an abdominal compression plate device. Normal tissues were delineated on daily axial T2‐weighted MR and compared on days 2 and 3 relative to day 1, after adjusting for baseline shifts relative to bony anatomy. Inter‐fraction organ deformation was computed using deformable registration of axial T2 images. Deformation > 5 mm was assumed to be clinically relevant. Inter‐fraction respiratory amplitude changes and intra‐fraction baseline drifts during imaging were quantified on daily orthogonal cine‐MR (70 s each), and changes > 3 mm were assumed to be relevant. Results On axial MR, the mean inter‐fraction normal tissue deformation was > 5 mm for all organs (range 5.1–13.4 mm). Inter‐fraction compression device misplacements > 5 mm and changes in stomach volume > 50% occurred at a rate of 93% and 38%, respectively, in one or more directions and were associated with larger adjacent organ deformation, in particular for the duodenum. On cine‐MR, inter‐fraction amplitude changes > 3 mm on day 2 and 3 relative to day 1 occurred at a rate of < 12.5% (mean superior–inferior change was 1.6 mm). Intra‐fraction baseline drifts > 3 mm during any cine‐MR acquisition occurred at a rate of 23% (mean superior–inferior changes was 2.4 mm). Conclusions Respiratory motion under abdominal compression is reproducible in most subjects within 3 mm. However, inter‐fraction deformations greater than 5 mm in normal tissues were common and larger than inter‐ and intra‐fraction respiratory changes. Deformations were driven mostly by variable stomach contents and device positioning. The magnitude of this motion may impact normal tissue dosimetry during stereotactic radiotherapy.

show abstract

Adaptive Liver Stereotactic Body Radiation Therapy: Automated Daily Plan Reoptimization Prevents Dose Delivery Degradation Caused by Anatomy Deformations

Cited by 21 publications

References 29 publications

Dose Escalated Liver Stereotactic Body Radiation Therapy at the Mean Respiratory Position

Dose Escalated Liver Stereotactic Body Radiation Therapy at the Mean Respiratory Position

The role of technology in clinical trials using stereotactic body radiotherapy

MRI evaluation of normal tissue deformation and breathing motion under an abdominal compression device

Contact Info

Product

Resources

About