Daily adaptive radiotherapy for patients with prostate cancer using a high field MR-linac: Initial clinical experiences and assessment of delivered doses compared to a C-arm linac
Daily adaptive radiotherapy for patients with prostate cancer using a high field MR-linac: Initial clinical experiences and assessment of delivered doses compared to a C-arm linac
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DOI：
10.1016/j.ctro.2020.04.011
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发表时间：
2020-07-01
影响因子：
3.1
通讯作者：
Oelfke, Uwe
中科院分区：
文献类型：
--
作者：
Dunlop, Alex;Mitchell, Adam;Oelfke, Uwe
引言：使用高场MR直线加速器的MR引导适应性放射治疗（MRgART）最近已经可用。我们报告的估计交付的部分剂量的前五个前列腺癌患者在我们的中心使用MRgART治疗，并比较这C臂直线加速器每日图像引导放射治疗（IGRT）。方法：患者接受治疗，采用适应性治疗计划塑造他们的日常解剖。在治疗输送前即刻采集的MR图像上重新计算治疗，以估计输送的部分剂量。C形臂直线加速器非适应VMAT治疗计划重新计算相同的MR图像估计的分数剂量，将已交付使用传统的放射治疗技术，使用每日IGRT protocol.Results：95%和93%的强制性目标覆盖率的目标和器官的风险剂量限制，分别实现了由MRgART和C形臂直线加速器提供的剂量估计。这两种交付技术估计已达到98%的强制性器官风险（OAR）的剂量限制，而为目标的临床目标，86%和80%，实现了MRgART和C臂直线加速器交付的剂量estimations.Conclusions：前列腺MRgART可以提供使用高场MR直线加速器。在C形臂直线加速器上进行的放射治疗为前列腺癌患者提供了一个很好的解决方案，这些患者在参考成像时具有有利的解剖结构，并在整个治疗过程中表现出稳定的解剖结构。对于在其参考图像上具有邻接靶体积的关键OAR的患者，我们已经证明了与C形臂直线加速器治疗相比，MRgART的靶剂量覆盖范围改善的潜力。(C)2020年，任作家。由Elsevier B.V.代表欧洲放射治疗和肿瘤学会发表。
Introduction: MR-guided adapted radiotherapy (MRgART) using a high field MR-linac has recently become available. We report the estimated delivered fractional dose of the first five prostate cancer patients treated at our centre using MRgART and compare this to C-Arm linac daily Image Guided Radiotherapy (IGRT).Methods: Patients were treated using adapted treatment plans shaped to their daily anatomy. The treatments were recalculated on an MR image acquired immediately prior to treatment delivery in order to estimate the delivered fractional dose. C-arm linac non-adapted VMAT treatment plans were recalculated on the same MR images to estimate the fractional dose that would have been delivered using conventional radiotherapy techniques using a daily IGRT protocol.Results: 95% and 93% of mandatory target coverage objectives and organ at risk dose constraints were achieved by MRgART and C-arm linac delivered dose estimates, respectively. Both delivery techniques were estimated to have achieved 98% of mandatory Organ At Risk (OAR) dose constraints whereas for the target clinical goals, 86% and 80% were achieved by MRgART and C-arm linac delivered dose estimates.Conclusions: Prostate MRgART can be delivered using the a high field MR-linac. Radiotherapy performed on a C-arm linac offers a good solution for prostate cancer patients who present with favourable anatomy at the time of reference imaging and demonstrate stable anatomy throughout the course of their treatment. For patients with critical OARs abutting target volumes on their reference image we have demonstrated the potential for a target dose coverage improvement for MRgART compared to C-arm linac treatment. (C) 2020 The Authors. Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.