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Forecasting patient-specific dosimetric benefit from daily online adaptive radiotherapy for cervical cancer.

Authors :
Ghimire R
Moore KL
Branco D
Rash DL
Mayadev J
Ray X
Source :
Biomedical physics & engineering express [Biomed Phys Eng Express] 2023 Jun 30; Vol. 9 (4). Date of Electronic Publication: 2023 Jun 30.
Publication Year :
2023

Abstract

Objective . Adaptive Radiotherapy (ART) is an emerging technique for treating cancer patients which facilitates higher delivery accuracy and has the potential to reduce toxicity. However, ART is also resource-intensive, Requiring extra human and machine time compared to standard treatment methods. In this analysis, we sought to predict the subset of node-negative cervical cancer patients with the greatest benefit from ART, so resources might be properly allocated to the highest-yield patients. Approach . CT images, initial plan data, and on-treatment Cone-Beam CT (CBCT) images for 20 retrospective cervical cancer patients were used to simulate doses from daily non-adaptive and adaptive techniques. We evaluated the coefficient of determination (R <superscript>2</superscript> ) between dose and volume metrics from initial treatment plans and the dosimetric benefits to theBowelV40Gy,BowelV45Gy,BladderDmean,andRectumDmeanfrom adaptive radiotherapy using reduced 3 mm or 5 mm CTV-to-PTV margins. The LASSO technique was used to identify the most predictive metrics forBowelV40Gy.The three highest performing metrics were used to build multivariate models with leave-one-out validation forBowelV40Gy. Main results . Patients with higher initial bowel doses were correlated with the largest decreases in BowelV40Gyfrom daily adaptation (linear best fit R <superscript>2</superscript> = 0.77 for a 3 mm PTV margin and R <superscript>2</superscript> = 0.8 for a 5 mm PTV margin). Other metrics had intermediate or no correlation. Selected covariates for the multivariate model were differences in the initialBowelV40GyandBladderDmeanusing standard versus reduced margins and the initial bladder volume. Leave-one-out validation had an R <superscript>2</superscript> of 0.66 between predicted and true adaptiveBowelV40Gybenefits for both margins. Significance . The resulting models could be used to prospectively triage cervical cancer patients on or off daily adaptation to optimally manage clinical resources. Additionally, this work presents a critical foundation for predicting benefits from daily adaptation that can be extended to other patient cohorts.<br /> (© 2023 IOP Publishing Ltd.)

Details

Language :
English
ISSN :
2057-1976
Volume :
9
Issue :
4
Database :
MEDLINE
Journal :
Biomedical physics & engineering express
Publication Type :
Academic Journal
Accession number :
37336202
Full Text :
https://doi.org/10.1088/2057-1976/acdf62