Impact of intrafraction motion in pancreatic cancer treatments with MR-guided adaptive radiation therapy

被引:1
|
作者
Rusu, Doris N. [1 ,2 ]
Cunningham, Justine M. [2 ]
Arch, Jacob V. [2 ]
Chetty, Indrin J. [2 ,3 ]
Parikh, Parag J. [2 ]
Dolan, Jennifer L. [2 ]
机构
[1] Wayne State Univ, Dept Radiat Oncol, Detroit, MI USA
[2] Henry Ford Hlth Syst, Dept Radiat Oncol, Detroit, MI 48202 USA
[3] Cedars Sinai Med Ctr, Dept Radiat Oncol, Los Angeles, CA USA
来源
FRONTIERS IN ONCOLOGY | 2023年 / 13卷
关键词
intrafraction motion; gastrointestinal motion; respiratory-gated radiation therapy; stereotactic body radiation therapy (SBRT); MR-linac; MR-guided radiation therapy; online adaptive radiation therapy; pancreatic cancer; RESONANCE; RADIOTHERAPY; FEASIBILITY;
D O I
10.3389/fonc.2023.1298099
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
PurposeThe total time of radiation treatment delivery for pancreatic cancer patients with daily online adaptive radiation therapy (ART) on an MR-Linac can range from 50 to 90 min. During this period, the target and normal tissues undergo changes due to respiration and physiologic organ motion. We evaluated the dosimetric impact of the intrafraction physiological organ changes.MethodsTen locally advanced pancreatic cancer patients were treated with 50 Gy in five fractions with intensity-modulated respiratory-gated radiation therapy on a 0.35-T MR-Linac. Patients received both pre- and post-treatment volumetric MRIs for each fraction. Gastrointestinal organs at risk (GI-OARs) were delineated on the pre-treatment MRI during the online ART process and retrospectively on the post-treatment MRI. The treated dose distribution for each adaptive plan was assessed on the post-treatment anatomy. Prescribed dose volume histogram metrics for the scheduled plan on the pre-treatment anatomy, the adapted plan on the pre-treatment anatomy, and the adapted plan on post-treatment anatomy were compared to the OAR-defined criteria for adaptation: the volume of the GI-OAR receiving greater than 33 Gy (V33Gy) should be <= 1 cubic centimeter.ResultsAcross the 50 adapted plans for the 10 patients studied, 70% were adapted to meet the duodenum constraint, 74% for the stomach, 12% for the colon, and 48% for the small bowel. Owing to intrafraction organ motion, at the time of post-treatment imaging, the adaptive criteria were exceeded for the duodenum in 62% of fractions, the stomach in 36%, the colon in 10%, and the small bowel in 48%. Compared to the scheduled plan, the post-treatment plans showed a decrease in the V33Gy, demonstrating the benefit of plan adaptation for 66% of the fractions for the duodenum, 95% for the stomach, 100% for the colon, and 79% for the small bowel.ConclusionPost-treatment images demonstrated that over the course of the adaptive plan generation and delivery, the GI-OARs moved from their isotoxic low-dose region and nearer to the dose-escalated high-dose region, exceeding dose-volume constraints. Intrafraction motion can have a significant dosimetric impact; therefore, measures to mitigate this motion are needed. Despite consistent intrafraction motion, plan adaptation still provides a dosimetric benefit.
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页数:9
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