Feasibility of Conebeam CT-based online adaptive radiotherapy for neoadjuvant treatment of rectal cancer.
Feasibility of Conebeam CT-based online adaptive radiotherapy for neoadjuvant treatment of rectal cancer.
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康奈束CT在线自适应放射治疗直肠癌新辅助治疗的可行性
DOI：
10.1186/s13014-021-01866-7
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发表时间：
2021-07-23
期刊：
影响因子：
--
通讯作者：
Bel A
中科院分区：
文献类型：
--
作者：
de Jong R;Visser J;van Wieringen N;Wiersma J;Geijsen D;Bel A
在线自适应放射治疗有可能减少直肠癌患者的毒性，因为整个临床靶体积（CTV）周围需要较小的计划靶体积（PTV）边缘。本研究的目的是描述基于Conebeam CT（CBCT）的直肠癌在线自适应工作流程的首次临床经验，评估工作流程中不同步骤的时间安排、计划质量、目标覆盖范围和患者依从性。12例符合5 × 5戈伊术前放疗条件的连续患者在环形直线加速器上接受治疗，每次分割时，治疗机旁均由多学科团队在场。加速器使用集成的软件平台进行操作，用于治疗计划和输送。在所有CTV的所有方向上，PTV边缘均为5 mm，但总CTV的头/尾侧边缘除外，其边缘为8 mm。根据单个计划CT生成参考计划。对准患者后，在线自适应程序开始采集CBCT。使用变形配准将计划CT扫描配准到CBCT，并生成合成CT扫描。在人工智能的支持下，系统调整结构引导变形和合成CT扫描轮廓，以匹配CBCT上的解剖结构。如有必要，在生成新计划之前调整这些轮廓。第二次和第三次CBCT分别在治疗前和治疗后对新计划的CTV覆盖范围进行了验证。使用容积调制弧治疗（VMAT）进行治疗。这一过程中的所有步骤都已确定并计时。平均而言，治疗机所需的时隙为34分钟。获取CBCT、评估和调整轮廓、创建新计划以及验证CBCT扫描上的CTV的过程平均耗时20分钟。包括输送和治疗后验证，这是26分钟。在50%的馏分中需要手动调整目标体积。计划质量、目标覆盖率和患者依从性都非常好。首次基于CBCT的在线自适应放射治疗的临床经验表明，它对直肠癌是可行的。试验注册涉及人类受试者的医学研究法案（WMO）不适用于本研究，并由学术医学中心医学伦理审查委员会（W21_087 # 21.097; Amsterdam University Medical Centers，Location Academic Medical Center，Amsterdam，The Netherlands）回顾性批准。在线版本包含补充材料，可通过10.1186/s13014-021-01866-7获得。
Online adaptive radiotherapy has the potential to reduce toxicity for patients treated for rectal cancer because smaller planning target volumes (PTV) margins around the entire clinical target volume (CTV) are required. The aim of this study is to describe the first clinical experience of a Conebeam CT (CBCT)-based online adaptive workflow for rectal cancer, evaluating timing of different steps in the workflow, plan quality, target coverage and patient compliance. Twelve consecutive patients eligible for 5 × 5 Gy pre-operative radiotherapy were treated on a ring-based linear accelerator with a multidisciplinary team present at the treatment machine for each fraction. The accelerator is operated using an integrated software platform for both treatment planning and delivery. In all directions for all CTVs a PTV margin of 5 mm was used, except for the cranial/caudal borders of the total CTV where a margin of 8 mm was applied. A reference plan was generated based on a single planning CT. After aligning the patient the online adaptive procedure started with acquisition of a CBCT. The planning CT scan was registered to the CBCT using deformable registration and a synthetic CT scan was generated. With the support of artificial intelligence, structure guided deformation and the synthetic CT scan contours were adapted by the system to match the anatomy on the CBCT. If necessary, these contours were adjusted before a new plan was generated. A second and third CBCT were acquired to validate the new plan with respect to CTV coverage just before and after treatment delivery, respectively. Treatment was delivered using volumetric modulated arc treatment (VMAT). All steps in this process were defined and timed. On average the timeslot needed at the treatment machine was 34 min. The process of acquiring a CBCT, evaluating and adjusting the contours, creating the new plan and verifying the CTV on the CBCT scan took on average 20 min. Including delivery and post treatment verification this was 26 min. Manual adjustments of the target volumes were necessary in 50% of fractions. Plan quality, target coverage and patient compliance were excellent. First clinical experience with CBCT-based online adaptive radiotherapy shows it is feasible for rectal cancer. Trial registration Medical Research Involving Human Subjects Act (WMO) does not apply to this study and was retrospectively approved by the Medical Ethics review Committee of the Academic Medical Center (W21_087 # 21.097; Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands). The online version contains supplementary material available at 10.1186/s13014-021-01866-7.
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影响因子：
5.7
作者：
Nijkamp, Jasper;Swellengrebel, Maurits;Sonke, Jan-Jakob
通讯作者：
Sonke, Jan-Jakob
影响因子：
5.7
作者：
Nijkamp, Jasper;de Jong, Rianne;Marijnen, Corrie
通讯作者：
Marijnen, Corrie
DOI：
10.1016/j.ijrobp.2004.04.016
发表时间：
2004-11-01
影响因子：
7
作者：
Duthoy, W;De Gersem, W;De Neve, W
通讯作者：
De Neve, W
影响因子：
5.7
作者：
Nijkamp, Jasper;de Jong, Rianne;Marijnen, Corrie
通讯作者：
Marijnen, Corrie
影响因子：
45.3
作者：
Peeters, KCMJ;van de Velde, CJH;Marijnen, CAM
通讯作者：
Marijnen, CAM