Image guided adaptive external beam radiation therapy for cervix cancer: Evaluation of a clinically implemented plan-of-the-day technique

Buschmann, Martin; Majercakova, K.; Sturdza, Alina; Smet, Sofie de; Najjari, D.; Daniel, Michaela; Pötter, Richard; Georg, Dietmar; Seppenwoolde, Yvette

doi:10.1016/j.zemedi.2017.09.004

Cited by 30 publications

(21 citation statements)

References 37 publications

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“…However, the need for adaptive strategies, based on the generation of multiple treatment plans, is largely accepted and some clinical tools, such as automatic planning tools [41], may ease their clinical implementation. Two ongoing clinical trials based on the use of the planning library showed that 3 to 15 min is required to select the plan-of-the-day at each treatment fraction [10,42].…”

Section: Ctv: Clinical Target Volumementioning

confidence: 99%

Statistical Shape Model to Generate a Planning Library for Cervical Adaptive Radiotherapy

Rigaud

Simon

Gobeli

et al. 2019

IEEE Trans. Med. Imaging

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External beam radiotherapy is extensively used to treat cervical carcinomas. A single planning CT scan enables the calculation of the dose distribution. The treatment is delivered over 5 weeks. Large per-treatment anatomical variations may hamper the dose delivery, with the potential of an organs at risk (OAR) overdose and a tumor underdose. To anticipate these deformations, a recent approach proposed three planning CTs with variable bladder volumes, which had the limitation of not covering all per-treatment anatomical variations. An original patient-specific population-based library has been proposed. It consisted of generating two representative anatomies, in addition to the standard planning CT anatomy. First, the cervix and bladder meshes of a population of 20 patients (314 images) were registered to an anatomical template, using a deformable mesh registration. An iterative point-matching algorithm was developed based on local shape context (histogram of polar or cylindrical coordinates and geodesic distance to the base) and on a topology constraint filter. Second, a standard principal component analysis (PCA) model of the cervix and bladder was generated to extract the dominant deformation modes. Finally, specific deformations were obtained using posterior PCA models, with a constraint representing the top of the uterus deformation. For a new patient, the cervix-uterus and bladder were registered to the template, and the patient's modeled planning library was built according to the model deformations. This method was applied following a leave-one-patient-out cross-validation. The performances of the modeled library were compared to those of the three-CT-based library and showing an improvement in both target coverage and OAR sparing.

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Section: Ctv: Clinical Target Volumementioning

confidence: 99%

Statistical Shape Model to Generate a Planning Library for Cervical Adaptive Radiotherapy

Rigaud

Simon

Gobeli

et al. 2019

IEEE Trans. Med. Imaging

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“…Large margins may however, reduce the clinical advantages of IMRT/VMAT. Different methods to deal with interfraction target-and organ motion have been explored, and image-guided adaptive strategies (IGART) such as library plan selection most often based on differences in bladder filling throughout the treatment have emerged [3][4][5][6][7][8][9]. Treating LACC patients with a full bladder is currently recommended to stabilize the target and further improve bowel sparing during external beam radiotherapy (EBRT).…”

Section: Introductionmentioning

confidence: 99%

Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer

Jensen

Assenholt

Fokdal

et al. 2019

Physics and Imaging in Radiation Oncology

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A B S T R A C TBackground and purpose: Organ motion is a challenge during high-precision external beam radiotherapy in cervical cancer, and improved strategies for treatment adaptation and monitoring of target dose coverage are needed. This study evaluates a cone beam computed tomography (CBCT)-based approach. Materials and methods: In twenty-three patients, individualized internal target volumes (ITVs) were generated from pre-treatment MRI and CT scans with full and empty bladders. The target volumes encompassed high-risk clinical target volume (CTV-T HR) (gross tumor volume + remaining cervix) and low risk (LR) CTV-T (CTV-T HR + uterus + parametriae + upper vagina). Volumetric Modulated Arc Therapy (VMAT) was used to deliver a dose of 45 Gy in 25 fractions. CBCTs were used for setup and for radiation therapists (RTTs) to evaluate the target coverage (inside/outside the planning target volume). CBCTs were reviewed offline. Estimates of the dose delivered with minimum (point) doses across all fractions to CTV-T HR (aim 42.75 Gy) and CTV-T LR (aim 40 Gy) were assessed. In patients with insufficient dose coverage, re-plans were generated based on previous imaging. Results: Median (range) of the ITV-margins (mean of anterior-posterior margins) related to uterus and cervix was 1.2 (0.5-2.2 and 1.0-2.1) cm. RTTs were able to assess the target coverage in 90% of all CBCTs (505/563). With re-planning, one patient had considerable benefit (12.7 Gy increase of minimum dose) to CTV-T LR_vagina, four patients had improved dose to the CTV-T LR_uterus (1.2-1.8 Gy), and 3 patients did not benefit from re-planning. Conclusions: Daily CBCT-based monitoring of target coverage by the RTTs has proven safe with limited workload. It allows for reduction in the treated volumes without compromising the target dose coverage.

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“…A similar approach has been used on a cohort of 16 patients. 42 In both studies, when facing logistic trouble with FIG. 5.…”

Section: Discussionmentioning

confidence: 96%

“…Heijkoop et al described another original personalized strategy using a library that includes model‐predicted internal target volumes (sub‐ITV) in a cohort of 64 patients with daily CBCTs. A similar approach has been used on a cohort of 16 patients . In both studies, when facing logistic trouble with implementing the planning library (e.g., image quality, OAR filling, tumor deformations), a backup plan was used.…”

Section: Discussionmentioning

confidence: 99%

“…The sub‐ITV library appears to also be an attractive option for avoiding the highest OAR coverage observed with the ITV strategy (Table ). The use of a library based on sub‐ITVs decreased the dose (V 40Gy ) to the bladder, rectum, and bowel in comparison with the ITV approach . Recently, statistical shape modeling was also used to assess the dose coverage probability of five patients with weekly CTs .…”

Section: Discussionmentioning

confidence: 99%

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CBCT‐guided evolutive library for cervical adaptive IMRT

et al. 2018

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Image guided adaptive external beam radiation therapy for cervix cancer: Evaluation of a clinically implemented plan-of-the-day technique

Cited by 30 publications

References 37 publications

Statistical Shape Model to Generate a Planning Library for Cervical Adaptive Radiotherapy

Statistical Shape Model to Generate a Planning Library for Cervical Adaptive Radiotherapy

Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer

CBCT‐guided evolutive library for cervical adaptive IMRT

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