Prospects for daily online adaptive radiotherapy via ethos for prostate cancer patients without nodal involvement using unedited CBCT auto-segmentation.
Prospects for daily online adaptive radiotherapy via ethos for prostate cancer patients without nodal involvement using unedited CBCT auto-segmentation.
复制标题
DOI：
10.1002/acm2.13399
复制
发表时间：
2021-10
影响因子：
2.1
通讯作者：
Ray X
中科院分区：
文献类型：
--
作者：
Moazzezi M;Rose B;Kisling K;Moore KL;Ray X
实施新的在线自适应放射治疗技术具有挑战性，因为需要额外的临床资源，特别是专家轮廓审查。在此，我们首次对瓦里安Ethos™前列腺癌自适应平台进行了评估，在自动分割后无需手动编辑，以最大限度地减少对临床效率的影响。使用Ethos™模拟器对25名之前在我们诊所接受过治疗的前列腺患者进行了重新计划。临床靶体积（CTV）包括完整的前列腺和近端精囊。使用了以下临床边缘：3 mm后、5 mm左/右/前和7 mm上级/下。使用Ethos的自动分割和自动计划工作流程计算每例患者10个部分的调整计划，无需手动轮廓编辑。将剂量和自动分割结构导出到我们的临床治疗计划系统，根据需要修改所有250个CTV和危及器官的轮廓。将调整计划的剂量指标与未调整计划进行比较，以评价CTV和OAR剂量变化。总体而言，96%的部分需要自动分割编辑，尽管校正通常很小（70%的CTV、88%的膀胱和90%的直肠<10%的体积）。然而，对于1例患者，自动分段CTV未能包括在所有10个部分延伸到膀胱的前列腺上级部分，导致CTV轮廓不足31.3% ± 6.7%。对于24例进行轻微自动分割校正的患者，自适应将CTV D98%改善了2.9% ± 5.3%。对于膀胱或直肠V90%超过临床阈值的非适应分数，适应分别使其降低13.1% ± 1.0%和6.5% ± 7.3%。 对于大多数患者，Ethos的在线自适应放射治疗工作流程将CTV D提高了98%，并在结构超过临床阈值时降低了正常组织剂量，即使没有耗时的手动编辑。然而，对于25例患者中的1例，需要进行大的轮廓编辑，因此有必要对每日自动分割进行审查，并非所有患者都是适应的良好候选人。
Implementing new online adaptive radiation therapy technologies is challenging because extra clinical resources are required particularly expert contour review. Here, we provide the first assessment of Varian's Ethos™ adaptive platform for prostate cancer using no manual edits after auto‐segmentation to minimize this impact on clinical efficiency. Twenty‐five prostate patients previously treated at our clinic were re‐planned using an Ethos™ emulator. Clinical target volumes (CTV) included intact prostate and proximal seminal vesicles. The following clinical margins were used: 3 mm posterior, 5 mm left/right/anterior, and 7 mm superior/inferior. Adapted plans were calculated for 10 fractions per patient using Ethos's auto‐segmentation and auto‐planning workflow without manual contouring edits. Doses and auto‐segmented structures were exported to our clinical treatment planning system where contours were modified as needed for all 250 CTVs and organs‐at‐risk. Dose metrics from adapted plans were compared to unadapted plans to evaluate CTV and OAR dose changes. Overall 96% of fractions required auto‐segmentation edits, although corrections were generally minor (<10% of the volume for 70% of CTVs, 88% of bladders, and 90% of rectums). However, for one patient the auto‐segmented CTV failed to include the superior portion of prostate that extended into the bladder at all 10 fractions resulting in under‐contouring of the CTV by 31.3% ± 6.7%. For the 24 patients with minor auto‐segmentation corrections, adaptation improved CTV D98% by 2.9% ± 5.3%. For non‐adapted fractions where bladder or rectum V90% exceeded clinical thresholds, adaptation reduced them by 13.1% ± 1.0% and 6.5% ± 7.3%, respectively. For most patients, Ethos's online adaptive radiation therapy workflow improved CTV D98% and reduced normal tissue dose when structures would otherwise exceed clinical thresholds, even without time‐consuming manual edits. However, for one in 25 patients, large contour edits were required and thus scrutiny of the daily auto‐segmentation is necessary and not all patients will be good candidates for adaptation.
登录
查看更多内容
影响因子：
3.8
作者：
Zhu, Xiaofeng;Ge, Yaorong;Wu, Q. Jackie
通讯作者：
Wu, Q. Jackie
DOI：
10.1016/s0360-3016(00)00608-8
发表时间：
2000-08-01
影响因子：
7
作者：
Yan, D;Lockman, D;Martinez, A
通讯作者：
Martinez, A
影响因子：
3.8
作者：
Appenzoller, Lindsey M.;Michalski, Jeff M.;Moore, Kevin L.
通讯作者：
Moore, Kevin L.
影响因子：
3.3
作者：
Kaderka, Robert;Mundt, Robert C.;Moore, Kevin L.
通讯作者：
Moore, Kevin L.
DOI：
10.1016/0360-3016(95)02081-0
发表时间：
1996-01-15
影响因子：
7
作者：
Beard, CJ;Kijewski, P;Coleman, CN
通讯作者：
Coleman, CN