Evaluation of PTV margins with daily iterative online adaptive radiotherapy for postoperative treatment of endometrial and cervical cancer: a prospective single-arm phase 2 study.
Evaluation of PTV margins with daily iterative online adaptive radiotherapy for postoperative treatment of endometrial and cervical cancer: a prospective single-arm phase 2 study.
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DOI：
10.1186/s13014-023-02394-2
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发表时间：
2024-01-04
影响因子：
3.6
通讯作者：
Zhang, Fuquan
中科院分区：
文献类型：
--
作者：
Wang, Guangyu;Wang, Zhiqun;Guo, Yuping;Zhang, Yu;Qiu, Jie;Hu, Ke;Li, Jing;Yan, Junfang;Zhang, Fuquan
关键词：
目的：确定子宫内膜癌和宫颈癌术后每日迭代锥束计算机断层扫描(ICBCT)引导的在线自适应放射治疗(OART)的最佳计划靶区体积(PTV)范围，以及减少PTV范围的益处。15名术后接受iCBCT引导下的OART治疗的子宫内膜癌和宫颈癌患者参加了这项前瞻性的第2阶段研究。获得5例患者治疗前后125个部位的iCBCT图像作为训练队列，分别绘制临床靶区(CTV)等值线。对PTVPre进行了统一的三维扩展，以评估包含CTVpost所需的最小边际。在另一组125次iCBCT扫描中，使用OART仿真器将所提出的在线自适应边缘与传统边缘计划(7-15 mm)的剂量学优势进行了比较。从CTV到PTV的扩展在来自10名患者的253个组分的验证队列中得到验证，并进一步研究了边际减少和急性毒性。从治疗前iCBCT到治疗后iCBCT的平均时间为22分钟。均一的PTV边缘为5 mm，100%(175/175)包绕结节CTVpost，98%(172/175)包绕阴道CTVpost。在我们的验证队列中验证了5 mm的边际，如果预测达到 ≥ 95%的闭路电视覆盖率，节点PTV边际可以进一步减少到4 mm。与传统的边缘计划相比，具有5 mm边缘的改良计划显著改善了盆腔危险器官的剂量学。只有一名白细胞减少的患者出现3级毒性反应，没有患者发生急性尿毒反应。在子宫内膜癌和宫颈癌的术后治疗中，OART可以将PTV切缘减少到5 mm，从而显著减少对危险关键器官的剂量，并潜在地降低急性毒性的发生率。网上版载有补充材料，可在10.1186/s13014-023-02394-2查阅。
To determine the optimal planning target volume (PTV) margins for adequate coverage by daily iterative cone-beam computed tomography (iCBCT)-guided online adaptive radiotherapy (oART) in postoperative treatment of endometrial and cervical cancer and the benefit of reducing PTV margins. Fifteen postoperative endometrial and cervical cancer patients treated with daily iCBCT-guided oART were enrolled in this prospective phase 2 study. Pre- and posttreatment iCBCT images of 125 fractions from 5 patients were obtained as a training cohort, and clinical target volumes (CTV) were contoured separately. Uniform three-dimensional expansions were applied to the PTVpre to assess the minimum margin required to encompass the CTVpost. The dosimetric advantages of the proposed online adaptive margins were compared with conventional margin plans (7–15 mm) using an oART emulator in another cohort of 125 iCBCT scans. A CTV-to-PTV expansion was verified on a validation cohort of 253 fractions from 10 patients, and further margin reduction and acute toxicity were studied. The average time from pretreatment iCBCT to posttreatment iCBCT was 22 min. A uniform PTV margin of 5 mm could encompass nodal CTVpost in 100% of the fractions (175/175) and vaginal CTVpost in 98% of the fractions (172/175). The margin of 5 mm was verified in our validation cohort, and the nodal PTV margin could be further reduced to 4 mm if ≥ 95% CTV coverage was predicted to be achieved. The adapted plan with a 5 mm margin significantly improved pelvic organ-at-risk dosimetry compared with the conventional margin plan. Grade 3 toxicities were observed in only one patient with leukopenia, and no patients experienced acute urinary toxicity. In the postoperative treatment of endometrial and cervical cancer, oART could reduce PTV margins to 5 mm, which significantly decrease the dose to critical organs at risk and potentially lead to a lower incidence of acute toxicity. The online version contains supplementary material available at 10.1186/s13014-023-02394-2.
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DOI：
10.1186/s13014-021-01866-7
发表时间：
2021-07-23
期刊：
Radiation oncology (London, England)
影响因子：
--
作者：
de Jong R;Visser J;van Wieringen N;Wiersma J;Geijsen D;Bel A
通讯作者：
Bel A
NRG肿瘤学/RTOG共识指南划定临床靶标体积的强度调节骨盆辐射疗法的术后治疗子宫内膜和宫颈癌：更新。
DOI：
10.1016/j.ijrobp.2020.08.061
发表时间：
2021-02-01
期刊：
International journal of radiation oncology, biology, physics
影响因子：
--
作者：
Small W Jr;Bosch WR;Harkenrider MM;Strauss JB;Abu-Rustum N;Albuquerque KV;Beriwal S;Creutzberg CL;Eifel PJ;Erickson BA;Fyles AW;Hentz CL;Jhingran A;Klopp AH;Kunos CA;Mell LK;Portelance L;Powell ME;Viswanathan AN;Yacoub JH;Yashar CM;Winter KA;Gaffney DK
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Gaffney DK
影响因子：
3.3
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影响因子：
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DOI：
10.1016/j.ijrobp.2008.10.086
发表时间：
2009-09-01
影响因子：
7
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通讯作者：
Calandrino, Riccardo