Evaluation of the clinical value of automatic online dose restoration for adaptive proton therapy of head and neck cancer
•An online adaptive strategy was compared to not-adaptation of robust clinical plans and offline adaptation.•Not-adapted robustly optimized plans achieved adequate target coverage in up to only 26% of repeated-CTs.•Dose restoration yielded adequate target coverage in 52% of repeated-CTs.•Dose restor...
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Veröffentlicht in: | Radiotherapy and oncology 2022-05, Vol.170, p.190-197 |
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creator | Borderías-Villarroel, Elena Taasti, Vicki Van Elmpt, Wouter Teruel-Rivas, S. Geets, X. Sterpin, E. |
description | •An online adaptive strategy was compared to not-adaptation of robust clinical plans and offline adaptation.•Not-adapted robustly optimized plans achieved adequate target coverage in up to only 26% of repeated-CTs.•Dose restoration yielded adequate target coverage in 52% of repeated-CTs.•Dose restoration reduced the dose to most organs-at-risk compared to not-adaptation of robust clinical plans.•Full offline adaptation was still required in 48% of repeated-CTs.
Intensity modulated proton therapy (IMPT) is highly sensitive to anatomical variations which can cause inadequate target coverage during treatment. This study compares not-adapted (NA) robust plans to two adaptive IMPT methods - a fully-offline adaptive (FOA) and a simplified automatic online adaptive strategy (dose restoration (DR)) to determine the benefit of DR, in head and neck cancer (HNC).
Robustly optimized clinical IMPT doses in planning-CTs (pCTs) were available for a cohort of 10 HNC patients. During robust re-optimization, DR used isodose contours, generated from the clinical dose on pCTs, and patient specific objectives to reproduce the clinical dose in every repeated-CT(rCT). For each rCT(n = 50), NA, DR and FOA plans were robustly evaluated.
An improvement in DVH-metrics and robustness was seen for DR and FOA plans compared to NA plans. For NA plans, 74%(37/50) of rCTs did not fulfill the CTV coverage criteria (D98%>95%Dprescription). DR improved target coverage, target homogeneity and variability on critical risk organs such as the spinal cord. After DR, 52%(26/50) of rCTs met all clinical goals. Because of large anatomical changes and/or inaccurate patient repositioning, 48%(24/50) of rCTs still needed full offline adaptation to ensure an optimal treatment since dose restoration was not able to re-establish the initial plan quality.
Robust optimization together with fully-automatized DR avoided offline adaptation in 52% of the cases. Implementation of dose restoration in clinical routine could ensure treatment plan optimality while saving valuable human and material resources to radiotherapy departments. |
doi_str_mv | 10.1016/j.radonc.2022.03.011 |
format | Article |
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Intensity modulated proton therapy (IMPT) is highly sensitive to anatomical variations which can cause inadequate target coverage during treatment. This study compares not-adapted (NA) robust plans to two adaptive IMPT methods - a fully-offline adaptive (FOA) and a simplified automatic online adaptive strategy (dose restoration (DR)) to determine the benefit of DR, in head and neck cancer (HNC).
Robustly optimized clinical IMPT doses in planning-CTs (pCTs) were available for a cohort of 10 HNC patients. During robust re-optimization, DR used isodose contours, generated from the clinical dose on pCTs, and patient specific objectives to reproduce the clinical dose in every repeated-CT(rCT). For each rCT(n = 50), NA, DR and FOA plans were robustly evaluated.
An improvement in DVH-metrics and robustness was seen for DR and FOA plans compared to NA plans. For NA plans, 74%(37/50) of rCTs did not fulfill the CTV coverage criteria (D98%>95%Dprescription). DR improved target coverage, target homogeneity and variability on critical risk organs such as the spinal cord. After DR, 52%(26/50) of rCTs met all clinical goals. Because of large anatomical changes and/or inaccurate patient repositioning, 48%(24/50) of rCTs still needed full offline adaptation to ensure an optimal treatment since dose restoration was not able to re-establish the initial plan quality.
Robust optimization together with fully-automatized DR avoided offline adaptation in 52% of the cases. Implementation of dose restoration in clinical routine could ensure treatment plan optimality while saving valuable human and material resources to radiotherapy departments.</description><identifier>ISSN: 0167-8140</identifier><identifier>EISSN: 1879-0887</identifier><identifier>DOI: 10.1016/j.radonc.2022.03.011</identifier><identifier>PMID: 35346754</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Head and neck cancer ; Intensity-modulated proton therapy ; Inter-fraction variation ; Online-adaptive proton therapy ; Robust treatment planning</subject><ispartof>Radiotherapy and oncology, 2022-05, Vol.170, p.190-197</ispartof><rights>2022 Elsevier B.V.</rights><rights>Copyright © 2022 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-f49fbf8592c722910da953b942b9e463188d81c46e5ed66ff52bad31cb0a41ef3</citedby><cites>FETCH-LOGICAL-c474t-f49fbf8592c722910da953b942b9e463188d81c46e5ed66ff52bad31cb0a41ef3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.radonc.2022.03.011$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3549,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35346754$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Borderías-Villarroel, Elena</creatorcontrib><creatorcontrib>Taasti, Vicki</creatorcontrib><creatorcontrib>Van Elmpt, Wouter</creatorcontrib><creatorcontrib>Teruel-Rivas, S.</creatorcontrib><creatorcontrib>Geets, X.</creatorcontrib><creatorcontrib>Sterpin, E.</creatorcontrib><title>Evaluation of the clinical value of automatic online dose restoration for adaptive proton therapy of head and neck cancer</title><title>Radiotherapy and oncology</title><addtitle>Radiother Oncol</addtitle><description>•An online adaptive strategy was compared to not-adaptation of robust clinical plans and offline adaptation.•Not-adapted robustly optimized plans achieved adequate target coverage in up to only 26% of repeated-CTs.•Dose restoration yielded adequate target coverage in 52% of repeated-CTs.•Dose restoration reduced the dose to most organs-at-risk compared to not-adaptation of robust clinical plans.•Full offline adaptation was still required in 48% of repeated-CTs.
Intensity modulated proton therapy (IMPT) is highly sensitive to anatomical variations which can cause inadequate target coverage during treatment. This study compares not-adapted (NA) robust plans to two adaptive IMPT methods - a fully-offline adaptive (FOA) and a simplified automatic online adaptive strategy (dose restoration (DR)) to determine the benefit of DR, in head and neck cancer (HNC).
Robustly optimized clinical IMPT doses in planning-CTs (pCTs) were available for a cohort of 10 HNC patients. During robust re-optimization, DR used isodose contours, generated from the clinical dose on pCTs, and patient specific objectives to reproduce the clinical dose in every repeated-CT(rCT). For each rCT(n = 50), NA, DR and FOA plans were robustly evaluated.
An improvement in DVH-metrics and robustness was seen for DR and FOA plans compared to NA plans. For NA plans, 74%(37/50) of rCTs did not fulfill the CTV coverage criteria (D98%>95%Dprescription). DR improved target coverage, target homogeneity and variability on critical risk organs such as the spinal cord. After DR, 52%(26/50) of rCTs met all clinical goals. Because of large anatomical changes and/or inaccurate patient repositioning, 48%(24/50) of rCTs still needed full offline adaptation to ensure an optimal treatment since dose restoration was not able to re-establish the initial plan quality.
Robust optimization together with fully-automatized DR avoided offline adaptation in 52% of the cases. Implementation of dose restoration in clinical routine could ensure treatment plan optimality while saving valuable human and material resources to radiotherapy departments.</description><subject>Head and neck cancer</subject><subject>Intensity-modulated proton therapy</subject><subject>Inter-fraction variation</subject><subject>Online-adaptive proton therapy</subject><subject>Robust treatment planning</subject><issn>0167-8140</issn><issn>1879-0887</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kE1r3DAQhkVoSDYf_yAUHXuxqy9_XQolpE0hkEtyFmNpxGrjtbaSvbD_vjLe9tiTYOZ5Z0YPIQ-clZzx-uuujGDDaErBhCiZLBnnF2TD26YrWNs2n8gmY03RcsWuyU1KO8aYYLK5IteykqpuKrUhp6cjDDNMPow0ODptkZrBj97AQJcOLlWYp7DPjKFhzE2kNiSkEdMU4hp1IVKwcJj8EekhhinX8qwIh9MyYItgKYyWjmg-qIHRYLwjlw6GhPfn95a8_3h6e3wuXl5__nr8_lIY1aipcKpzvWurTphGiI4zC10l-06JvkNVS962tuVG1VihrWvnKtGDldz0DBRHJ2_Jl3VuPuv3nG_We58MDgOMGOakRa1UpyrFWUbVipoYUoro9CH6PcST5kwv0vVOr9L1Il0zqbP0HPt83jD3e7T_Qn8tZ-DbCmD-59Fj1Ml4zBKsj2gmbYP__4Y_8NuWpA</recordid><startdate>202205</startdate><enddate>202205</enddate><creator>Borderías-Villarroel, Elena</creator><creator>Taasti, Vicki</creator><creator>Van Elmpt, Wouter</creator><creator>Teruel-Rivas, S.</creator><creator>Geets, X.</creator><creator>Sterpin, E.</creator><general>Elsevier B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202205</creationdate><title>Evaluation of the clinical value of automatic online dose restoration for adaptive proton therapy of head and neck cancer</title><author>Borderías-Villarroel, Elena ; Taasti, Vicki ; Van Elmpt, Wouter ; Teruel-Rivas, S. ; Geets, X. ; Sterpin, E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-f49fbf8592c722910da953b942b9e463188d81c46e5ed66ff52bad31cb0a41ef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Head and neck cancer</topic><topic>Intensity-modulated proton therapy</topic><topic>Inter-fraction variation</topic><topic>Online-adaptive proton therapy</topic><topic>Robust treatment planning</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Borderías-Villarroel, Elena</creatorcontrib><creatorcontrib>Taasti, Vicki</creatorcontrib><creatorcontrib>Van Elmpt, Wouter</creatorcontrib><creatorcontrib>Teruel-Rivas, S.</creatorcontrib><creatorcontrib>Geets, X.</creatorcontrib><creatorcontrib>Sterpin, E.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Radiotherapy and oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Borderías-Villarroel, Elena</au><au>Taasti, Vicki</au><au>Van Elmpt, Wouter</au><au>Teruel-Rivas, S.</au><au>Geets, X.</au><au>Sterpin, E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of the clinical value of automatic online dose restoration for adaptive proton therapy of head and neck cancer</atitle><jtitle>Radiotherapy and oncology</jtitle><addtitle>Radiother Oncol</addtitle><date>2022-05</date><risdate>2022</risdate><volume>170</volume><spage>190</spage><epage>197</epage><pages>190-197</pages><issn>0167-8140</issn><eissn>1879-0887</eissn><abstract>•An online adaptive strategy was compared to not-adaptation of robust clinical plans and offline adaptation.•Not-adapted robustly optimized plans achieved adequate target coverage in up to only 26% of repeated-CTs.•Dose restoration yielded adequate target coverage in 52% of repeated-CTs.•Dose restoration reduced the dose to most organs-at-risk compared to not-adaptation of robust clinical plans.•Full offline adaptation was still required in 48% of repeated-CTs.
Intensity modulated proton therapy (IMPT) is highly sensitive to anatomical variations which can cause inadequate target coverage during treatment. This study compares not-adapted (NA) robust plans to two adaptive IMPT methods - a fully-offline adaptive (FOA) and a simplified automatic online adaptive strategy (dose restoration (DR)) to determine the benefit of DR, in head and neck cancer (HNC).
Robustly optimized clinical IMPT doses in planning-CTs (pCTs) were available for a cohort of 10 HNC patients. During robust re-optimization, DR used isodose contours, generated from the clinical dose on pCTs, and patient specific objectives to reproduce the clinical dose in every repeated-CT(rCT). For each rCT(n = 50), NA, DR and FOA plans were robustly evaluated.
An improvement in DVH-metrics and robustness was seen for DR and FOA plans compared to NA plans. For NA plans, 74%(37/50) of rCTs did not fulfill the CTV coverage criteria (D98%>95%Dprescription). DR improved target coverage, target homogeneity and variability on critical risk organs such as the spinal cord. After DR, 52%(26/50) of rCTs met all clinical goals. Because of large anatomical changes and/or inaccurate patient repositioning, 48%(24/50) of rCTs still needed full offline adaptation to ensure an optimal treatment since dose restoration was not able to re-establish the initial plan quality.
Robust optimization together with fully-automatized DR avoided offline adaptation in 52% of the cases. Implementation of dose restoration in clinical routine could ensure treatment plan optimality while saving valuable human and material resources to radiotherapy departments.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>35346754</pmid><doi>10.1016/j.radonc.2022.03.011</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Head and neck cancer Intensity-modulated proton therapy Inter-fraction variation Online-adaptive proton therapy Robust treatment planning |
title | Evaluation of the clinical value of automatic online dose restoration for adaptive proton therapy of head and neck cancer |
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