1. Nine years of plan of the day for cervical cancer: Plan library remains effective compared to fully online-adaptive techniques.
- Author
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Reijtenbagh D, Godart J, Penninkhof J, Quint S, Zolnay A, Mens JW, and Hoogeman M
- Subjects
- Female, Humans, Organs at Risk, Radiotherapy Planning, Computer-Assisted methods, Urinary Bladder, Radiotherapy Dosage, Uterine Cervical Neoplasms diagnostic imaging, Uterine Cervical Neoplasms radiotherapy, Radiotherapy, Image-Guided methods, Radiotherapy, Intensity-Modulated methods
- Abstract
Background and Purpose: Since 2011, our center has been using a library-based Plan-of-the-Day (PotD) strategy for external beam radiotherapy of cervical cancer patients to reduce normal tissue dose while maintaining adequate target coverage. With the advent of fully online-adaptive techniques such as daily online-adaptive replanning, further dose reduction may be possible. However, it is unknown how this reduction relates to plan library approaches, and how the most recent PotD strategies relate to no adaptation. In this study we compare the performance of our current PotD strategy with non-adaptive and fully online-adaptive techniques in terms of target volume size and normal tissue sparing., Materials and Methods: Treatment data of 376 patients treated with the PotD protocol between June 2011 and April 2020 were included. The size of the Planning Target Volumes (PTVs) was reconstructed for different strategies: full online adaptation, no adaptation, and the latest clinical version of the PotD protocol. Normal tissue sparing was estimated by the difference in margin volume to construct the PTV and the volume overlap of the PTV with bladder and rectum., Results: The current version of our PotD approach reduced the PTV margin volume by a median of 250 cm
3 compared to no adaptation. Bladder-PTV overlap decreased from a median of 142 to 71 cm3 , and from 39 to 16 cm3 for rectum-PTV. Fully online-adaptive approaches could further decrease the PTV volume by 144 cm3 using a 5 mm margin for residual errors. In this scenario, bladder-PTV overlap was reduced to 35 cm3 and rectum-PTV overlap to 11 cm3 ., Conclusion: The current version of the PotD protocol is an effective technique to improve normal tissue sparing compared to no adaptation. Further sparing can be achieved using fully online-adaptive techniques, but at the cost of a more complex workflow and with a potentially limited impact. PotD-type protocols can therefore be considered as a suitable alternative to fully online-adaptive approaches., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)- Published
- 2024
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