Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer
© 2018 The Authors..
BACKGROUND 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:9 |
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| Enthalten in: |
Physics and imaging in radiation oncology - 9(2019) vom: 24. Jan., Seite 14-20 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Jensen, Nina Boje Kibsgaard [VerfasserIn] |
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| Links: |
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| Themen: |
Adaptive radiotherapy |
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| Anmerkungen: |
Date Revised 20.04.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.phro.2018.12.002 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM320210308 |
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| 100 | 1 | |a Jensen, Nina Boje Kibsgaard |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer |
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| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2018 The Authors. | ||
| 520 | |a BACKGROUND 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Adaptive radiotherapy | |
| 650 | 4 | |a Cervical cancer | |
| 650 | 4 | |a Cone-beam computed tomography | |
| 650 | 4 | |a External beam radiotherapy | |
| 650 | 4 | |a Image guidance | |
| 650 | 4 | |a Interfraction motion | |
| 700 | 1 | |a Assenholt, Marianne Sanggaard |e verfasserin |4 aut | |
| 700 | 1 | |a Fokdal, Lars Ulrik |e verfasserin |4 aut | |
| 700 | 1 | |a Vestergaard, Anne |e verfasserin |4 aut | |
| 700 | 1 | |a Schouboe, Annette |e verfasserin |4 aut | |
| 700 | 1 | |a Kjaersgaard, Eva Bruun |e verfasserin |4 aut | |
| 700 | 1 | |a Boejen, Annette |e verfasserin |4 aut | |
| 700 | 1 | |a Nyvang, Lars |e verfasserin |4 aut | |
| 700 | 1 | |a Lindegaard, Jacob Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Tanderup, Kari |e verfasserin |4 aut | |
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