Online adaptive radiotherapy for bladder cancer using a simultaneous integrated boost and fiducial markers

Radiation Oncology

Research

Jakko Nieuwenhuijzen¹  Maarten Hulshof²  Arjan Bel²  Niek van Wieringen²  Jorrit Visser²  Laurien Daniëls²  Karin Goudschaal²  Jan Wiersma²  Duncan den Boer³  Marjan Admiraal³  Sana Azzarouali⁴ 

[1] Cancer Center Amsterdam, Cancer Therapy, Treatment and quality of life, Amsterdam, The Netherlands;Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Urology, Amsterdam, The Netherlands;Cancer Center Amsterdam, Cancer Therapy, Treatment and quality of life, Amsterdam, The Netherlands;Radiation Oncology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands;Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands;Cancer Center Amsterdam, Cancer Therapy, Treatment and quality of life, Amsterdam, The Netherlands;Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands;Cancer Center Amsterdam, Cancer Therapy, Treatment and quality of life, Amsterdam, The Netherlands;Radiation Oncology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands;

关键词: Online adaptive radiotherapy;    Bladder cancer;    Fiducial markers;    Reoptimization;    Artificial intelligence;    Radiotherapy;    CBCT;    Focal boost;    Cone Beam CT;   

DOI  :  10.1186/s13014-023-02348-8

 received in 2023-05-12, accepted in 2023-09-10,  发布年份 2023

来源: Springer

【 摘 要 】

PurposeThe aim was to assess the feasibility of online adaptive radiotherapy (oART) for bladder cancer using a focal boost by focusing on the quality of the online treatment plan and automatic target delineation, duration of the workflow and performance in the presence of fiducial markers for tumor bed localization.MethodsFifteen patients with muscle invasive bladder cancer received daily oART with Cone Beam CT (CBCT), artificial intelligence (AI)-assisted automatic delineation of the daily anatomy and online plan reoptimization. The bladder and pelvic lymph nodes received a total dose of 40 Gy in 20 fractions, the tumor received an additional simultaneously integrated boost (SIB) of 15 Gy. The dose distribution of the reference plan was calculated for the daily anatomy, i.e. the scheduled plan. Simultaneously, a reoptimization of the plan was performed i.e. the adaptive plan. The target coverage and V95% outside the target were evaluated for both plans. The need for manual adjustments of the GTV delineation, the duration of the workflow and the influence of fiducial markers were assessed.ResultsAll 300 adaptive plans met the requirement of the CTV-coverage V95%≥98% for both the boost (55 Gy) and elective volume (40 Gy). For the scheduled plans the CTV-coverage was 53.5% and 98.5%, respectively. Significantly less tissue outside the targets received 55 Gy in case of the adaptive plans as compared to the scheduled plans. Manual corrections of the GTV were performed in 67% of the sessions. In 96% of these corrections the GTV was enlarged and resulted in a median improvement of 1% for the target coverage. The median on-couch time was 22 min. A third of the session time consisted of reoptimization of the treatment plan. Fiducial markers were visible on the CBCTs and aided the tumor localization.ConclusionsAI-driven CBCT-guided oART aided by fiducial markers is feasible for bladder cancer radiotherapy treatment including a SIB. The quality of the adaptive plans met the clinical requirements and fiducial markers were visible enabling consistent daily tumor localization. Improved automatic delineation to lower the need for manual corrections and faster reoptimization would result in shorter session time.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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