Fractionation versus Adaptation for Compensation of Target Volume Changes during Online Adaptive Radiotherapy for Bladder Cancer: Answers from a Prospective Registry
Online adaptive radiotherapy (ART) allows adaptation of the dose distribution to the anatomy captured by with pre-adaptation imaging. ART is time-consuming, and thus intra-fractional deformations can occur. This prospective registry study analyzed the effects of intra-fraction deformations of clinic...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-10-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/20/4933 |
| _version_ | 1797574398716149760 |
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| author | Christoph Pöttgen Christian Hoffmann Thomas Gauler Maja Guberina Nika Guberina Toke Ringbaek Alina Santiago Garcia Ulrich Krafft Boris Hadaschik Aymane Khouya Martin Stuschke |
| author_facet | Christoph Pöttgen Christian Hoffmann Thomas Gauler Maja Guberina Nika Guberina Toke Ringbaek Alina Santiago Garcia Ulrich Krafft Boris Hadaschik Aymane Khouya Martin Stuschke |
| author_sort | Christoph Pöttgen |
| collection | DOAJ |
| description | Online adaptive radiotherapy (ART) allows adaptation of the dose distribution to the anatomy captured by with pre-adaptation imaging. ART is time-consuming, and thus intra-fractional deformations can occur. This prospective registry study analyzed the effects of intra-fraction deformations of clinical target volume (CTV) on the equivalent uniform dose (EUD<sub>CTV</sub>) of focal bladder cancer radiotherapy. Using margins of 5–10 mm around CTV on pre-adaptation imaging, intra-fraction CTV-deformations found in a second imaging study reduced the 10th percentile of EUD<sub>CTV</sub> values per fraction from 101.1% to 63.2% of the prescribed dose. Dose accumulation across fractions of a series was determined with deformable-image registration and worst-case dose accumulation that maximizes the correlation of cold spots. A strong fractionation effect was demonstrated—the EUD<sub>CTV</sub> was above 95% and 92.5% as determined by the two abovementioned accumulation methods, respectively, for all series of dose fractions. A comparison of both methods showed that the fractionation effect caused the EUD<sub>CTV</sub> of a series to be insensitive to EUD<sub>CTV</sub>-declines per dose fraction, and this could be explained by the small size and spatial variations of cold spots. Therefore, ART for each dose fraction is unnecessary, and selective ART for fractions with large inter-fractional deformations alone is sufficient for maintaining a high EUD<sub>CTV</sub> for a radiotherapy series. |
| first_indexed | 2024-03-10T21:23:03Z |
| format | Article |
| id | doaj.art-e6baeeb532b54e94b0c95549840eea92 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T21:23:03Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-e6baeeb532b54e94b0c95549840eea922023-11-19T15:58:09ZengMDPI AGCancers2072-66942023-10-011520493310.3390/cancers15204933Fractionation versus Adaptation for Compensation of Target Volume Changes during Online Adaptive Radiotherapy for Bladder Cancer: Answers from a Prospective RegistryChristoph Pöttgen0Christian Hoffmann1Thomas Gauler2Maja Guberina3Nika Guberina4Toke Ringbaek5Alina Santiago Garcia6Ulrich Krafft7Boris Hadaschik8Aymane Khouya9Martin Stuschke10Department of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyDepartment of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyDepartment of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyDepartment of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyDepartment of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyDepartment of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyDepartment of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyDepartment of Urology, University of Duisburg-Essen, 45147 Essen, GermanyDepartment of Urology, University of Duisburg-Essen, 45147 Essen, GermanyDepartment of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyDepartment of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyOnline adaptive radiotherapy (ART) allows adaptation of the dose distribution to the anatomy captured by with pre-adaptation imaging. ART is time-consuming, and thus intra-fractional deformations can occur. This prospective registry study analyzed the effects of intra-fraction deformations of clinical target volume (CTV) on the equivalent uniform dose (EUD<sub>CTV</sub>) of focal bladder cancer radiotherapy. Using margins of 5–10 mm around CTV on pre-adaptation imaging, intra-fraction CTV-deformations found in a second imaging study reduced the 10th percentile of EUD<sub>CTV</sub> values per fraction from 101.1% to 63.2% of the prescribed dose. Dose accumulation across fractions of a series was determined with deformable-image registration and worst-case dose accumulation that maximizes the correlation of cold spots. A strong fractionation effect was demonstrated—the EUD<sub>CTV</sub> was above 95% and 92.5% as determined by the two abovementioned accumulation methods, respectively, for all series of dose fractions. A comparison of both methods showed that the fractionation effect caused the EUD<sub>CTV</sub> of a series to be insensitive to EUD<sub>CTV</sub>-declines per dose fraction, and this could be explained by the small size and spatial variations of cold spots. Therefore, ART for each dose fraction is unnecessary, and selective ART for fractions with large inter-fractional deformations alone is sufficient for maintaining a high EUD<sub>CTV</sub> for a radiotherapy series.https://www.mdpi.com/2072-6694/15/20/4933online adaptive radiotherapybladder cancerdose accumulationequivalent uniform dose |
| spellingShingle | Christoph Pöttgen Christian Hoffmann Thomas Gauler Maja Guberina Nika Guberina Toke Ringbaek Alina Santiago Garcia Ulrich Krafft Boris Hadaschik Aymane Khouya Martin Stuschke Fractionation versus Adaptation for Compensation of Target Volume Changes during Online Adaptive Radiotherapy for Bladder Cancer: Answers from a Prospective Registry Cancers online adaptive radiotherapy bladder cancer dose accumulation equivalent uniform dose |
| title | Fractionation versus Adaptation for Compensation of Target Volume Changes during Online Adaptive Radiotherapy for Bladder Cancer: Answers from a Prospective Registry |
| title_full | Fractionation versus Adaptation for Compensation of Target Volume Changes during Online Adaptive Radiotherapy for Bladder Cancer: Answers from a Prospective Registry |
| title_fullStr | Fractionation versus Adaptation for Compensation of Target Volume Changes during Online Adaptive Radiotherapy for Bladder Cancer: Answers from a Prospective Registry |
| title_full_unstemmed | Fractionation versus Adaptation for Compensation of Target Volume Changes during Online Adaptive Radiotherapy for Bladder Cancer: Answers from a Prospective Registry |
| title_short | Fractionation versus Adaptation for Compensation of Target Volume Changes during Online Adaptive Radiotherapy for Bladder Cancer: Answers from a Prospective Registry |
| title_sort | fractionation versus adaptation for compensation of target volume changes during online adaptive radiotherapy for bladder cancer answers from a prospective registry |
| topic | online adaptive radiotherapy bladder cancer dose accumulation equivalent uniform dose |
| url | https://www.mdpi.com/2072-6694/15/20/4933 |
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