Identification of patients with locally advanced pancreatic cancer benefitting from plan adaptation in MR-guided radiation therapy.
Adult
Aged
Aged, 80 and over
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasms, Second Primary
Organs at Risk
/ diagnostic imaging
Pancreatic Neoplasms
/ diagnostic imaging
Radiotherapy Planning, Computer-Assisted
/ methods
Radiotherapy, Image-Guided
/ methods
Radiotherapy, Intensity-Modulated
Tomography, X-Ray Computed
Adaptive
LAPC
MR-guided
MRgRT
Pancreatic cancer
SBRT
Journal
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
ISSN: 1879-0887
Titre abrégé: Radiother Oncol
Pays: Ireland
ID NLM: 8407192
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
06
09
2018
revised:
27
11
2018
accepted:
28
11
2018
entrez:
4
3
2019
pubmed:
4
3
2019
medline:
29
1
2020
Statut:
ppublish
Résumé
MR-guided radiation therapy (MRgRT) with daily plan adaptation is a novel but time- and resource-intensive treatment for locally advanced pancreatic cancer (LAPC). We analyzed the benefit in target coverage and organ-at-risk (OAR) sparing of daily plan adaptation in 36 consecutive LAPC patients treated with MRgRT to 40 Gy in 5 fractions. Adaptive planning was assessed for 180 fractions by comparing non-adapted plans with re-optimized plans using (a) GTV coverage and OAR high-doses, and (b) compliance with institutional objectives for GTV coverage and high-dose OAR constraints. Using these criteria, plan adaptation for each fraction was characterized as "not needed", "beneficial", or "no benefit". Decision-tree analysis was performed to identify subgroups most likely or not to benefit from routine plan adaptation. The percentage of plans fulfilling institutional constraints increased from 43.9% (non-adapted plans) to 83.3% after online plan adaptation, with significant improvements in GTV coverage and lower V MRgRT with daily plan adaptation for LAPC was of benefit in approximately half of fractions, improving target coverage and OAR sparing. Plan adaptation appeared to be relevant mainly in cases where the GTV to adjacent OAR distance was ≤3 mm.
Sections du résumé
BACKGROUND AND PURPOSE
MR-guided radiation therapy (MRgRT) with daily plan adaptation is a novel but time- and resource-intensive treatment for locally advanced pancreatic cancer (LAPC). We analyzed the benefit in target coverage and organ-at-risk (OAR) sparing of daily plan adaptation in 36 consecutive LAPC patients treated with MRgRT to 40 Gy in 5 fractions.
MATERIALS AND METHODS
Adaptive planning was assessed for 180 fractions by comparing non-adapted plans with re-optimized plans using (a) GTV coverage and OAR high-doses, and (b) compliance with institutional objectives for GTV coverage and high-dose OAR constraints. Using these criteria, plan adaptation for each fraction was characterized as "not needed", "beneficial", or "no benefit". Decision-tree analysis was performed to identify subgroups most likely or not to benefit from routine plan adaptation.
RESULTS
The percentage of plans fulfilling institutional constraints increased from 43.9% (non-adapted plans) to 83.3% after online plan adaptation, with significant improvements in GTV coverage and lower V
CONCLUSION
MRgRT with daily plan adaptation for LAPC was of benefit in approximately half of fractions, improving target coverage and OAR sparing. Plan adaptation appeared to be relevant mainly in cases where the GTV to adjacent OAR distance was ≤3 mm.
Identifiants
pubmed: 30825964
pii: S0167-8140(18)33613-2
doi: 10.1016/j.radonc.2018.11.019
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
16-22Informations de copyright
Copyright © 2018 Elsevier B.V. All rights reserved.