Initial Feasibility and Clinical Implementation of Daily MR-Guided Adaptive Head and Neck Cancer Radiation Therapy on a 1.5T MR-Linac System: Prospective R-IDEAL 2a/2b Systematic Clinical Evaluation of Technical Innovation.
Initial Feasibility and Clinical Implementation of Daily MR-Guided Adaptive Head and Neck Cancer Radiation Therapy on a 1.5T MR-Linac System: Prospective R-IDEAL 2a/2b Systematic Clinical Evaluation of Technical Innovation.
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DOI：
10.1016/j.ijrobp.2020.12.015
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发表时间：
2021-04-01
期刊：
影响因子：
--
通讯作者：
MR-Linac Consortium Head and Neck Tumor Site Group
中科院分区：
文献类型：
--
作者：
McDonald BA;Vedam S;Yang J;Wang J;Castillo P;Lee B;Sobremonte A;Ahmed S;Ding Y;Mohamed ASR;Balter P;Hughes N;Thorwarth D;Nachbar M;Philippens MEP;Terhaard CHJ;Zips D;Böke S;Awan MJ;Christodouleas J;Fuller CD;MR-Linac Consortium Head and Neck Tumor Site Group
这项前瞻性研究是使用1.5T MR直线加速器进行头颈癌（HNC）每日自适应放射治疗（ART）的第一份报告，特别关注基于在线刚性配准的自适应定位（ATP）工作流程的安全性和可行性以及剂量测定结果。10名HNC患者在1.5T/7 MV MR直线加速器上接受每日ART，6名仅使用ATP，4名使用ATP，1名离线适应形状重新计划。通过计算平均系统误差（M）、系统误差的标准差（Σ）和等中心点偏移的随机误差的标准差（σ），评估定制固定面罩的设置变异性。采用3%/3 mm γ标准，用圆柱形二极管阵列进行质量保证。对每例患者的适应性治疗计划进行汇总，以比较输送剂量与参考计划的计划剂量。通过跟踪每个单独部分的优化约束违反次数，评估自适应部分之间的剂量测定变异性对总和计划剂量的影响。x、y和z等中心移动的随机误差（mm）分别为M = −0.3、0.7、0.1; Σ = 3.3、2.6、1.4; σ = 1.7、2.9、1.0。中位γ通过率为99.9%（范围：90.9%-100%）。CTV的参考和总和计划剂量之间的差异在[-0.61%，1.78%]范围内，危及器官（OAR）的差异在[-11.74%，8.11%]范围内，尽管OAR剂量增加2%以上的百分比仅发生在3例病例中，每例病例均为单一OAR。所有情况下，至少有两个分数与一个或多个约束违规。然而，在几乎所有情况下，尽管存在多个单分数违规，但总和计划仍符合约束条件。使用在线ATP工作流程在1.5T MR直线加速器上进行每日ART对于HNC是安全的，临床上可行的，并且导致输送剂量与计划剂量一致。
This prospective study is the first report of daily adaptive radiotherapy (ART) for head & neck cancers (HNC) using a 1.5T MR-linac, with particular focus on safety & feasibility and dosimetric results of an on-line rigid registration-based adapt-to-position (ATP) workflow. Ten HNC patients received daily ART on a 1.5T/7MV MR-linac, six using ATP only and four using ATP with one off-line adapt-to-shape re-plan. Setup variability with custom immobilization masks was assessed by calculating the average systematic error (M), standard deviation of the systematic error (Σ), and standard deviation of the random error (σ) of the isocenter shifts. Quality assurance was performed with a cylindrical diode array using 3%/3mm γ criteria. Adaptive treatment plans were summed for each patient to compare delivered dose with planned dose from the reference plan. The impact of dosimetric variability between adaptive fractions on the summation plan doses was assessed by tracking the number of optimization constraint violations at each individual fraction. The random errors (mm) for the x, y, and z isocenter shifts, respectively, were M = −0.3, 0.7, 0.1; Σ = 3.3, 2.6, 1.4; and σ = 1.7, 2.9, 1.0. The median γ pass rate was 99.9% (range: 90.9%−100%). The differences between the reference and summation plan doses were within [−0.61%, 1.78%] for the CTV and [−11.74%, 8.11%] for organs at risk (OARs), though percent increases in OAR dose above 2% only occurred in three cases, each for a single OAR. All cases had at least two fractions with one or more constraint violations. However, in nearly all instances, constraints were still met in the summation plan despite multiple single-fraction violations. Daily ART on a 1.5T MR-linac using an on-line ATP workflow is safe and clinically feasible for HNC and results in delivered doses consistent with planned doses.
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影响因子：
3.6
作者：
Belshaw, Louise;Agnew, Christina E.;McGarry, Conor K.
通讯作者：
McGarry, Conor K.
DOI：
10.1016/j.radonc.2020.09.046
发表时间：
2020-12
期刊：
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
影响因子：
--
作者：
Kooreman ES;van Houdt PJ;Keesman R;Pos FJ;van Pelt VWJ;Nowee ME;Wetscherek A;Tijssen RHN;Philippens MEP;Thorwarth D;Wang J;Shukla-Dave A;Hall WA;Paulson ES;van der Heide UA
通讯作者：
van der Heide UA
影响因子：
3.8
作者：
Miften, Moyed;Olch, Arthur;Low, Daniel A.
通讯作者：
Low, Daniel A.
影响因子：
3.8
作者：
Brock, Kristy K.;Mutic, Sasa;Kessler, Marc L.
通讯作者：
Kessler, Marc L.
影响因子：
3.5
作者：
Lagendijk, Jan J. W.;Raaymakers, Bas W.;van Vulpen, Marco
通讯作者：
van Vulpen, Marco