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Dosimetric advantages of adaptive IMPT vs. Enhanced workload and treatment time - A need for automation.

Authors :
Oud M
Breedveld S
Giżyńska M
Chen YH
Habraken S
Perkó Z
Heijmen B
Hoogeman M
Source :
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2024 Sep 28; Vol. 201, pp. 110548. Date of Electronic Publication: 2024 Sep 28.
Publication Year :
2024
Publisher :
Ahead of Print

Abstract

Introduction: In head-and-neck IMPT, trigger-based offline plan adaptation (Offline <subscript>trigger-based</subscript> ) is often used. Our goal was to compare this to four alternative adaptive strategies for dosimetry, workload and treatment time, considering also foreseen further technological advancements, including anticipated automation.<br />Materials and Methods: Alternative strategies included weekly offline re-planning (Offline <subscript>weekly</subscript> ), daily plan selection from a library (Library <subscript>static</subscript> and Library <subscript>progsressive</subscript> ) and a fast, approximate daily online re-optimization approach (Online <subscript>re-opt</subscript> ). Impact on CTV coverage and NTCPs was assessed by simulations based on repeat-CTs from 15 patients. Full daily re-planning was used as dosimetric benchmark. Increases in workload and treatment time were estimated.<br />Results: Both for coverage and NTCPs, fast Online <subscript>re-opt</subscript> performed as well as full re-planning. Compared to current practice, Online <subscript>re</subscript> <subscript>-opt</subscript> showed enhanced probabilities for high coverage, and resulted in reductions in grade ≥ II NTCPs of 4.6 ± 1.7 %-point for xerostomia and 4.2 ± 2.3 %-point for dysphagia. Offline <subscript>weekly</subscript> and library strategies did not show coverage enhancements and resulted in smaller NTCP improvements. Further automation can largely limit workload and treatment time increases. With anticipated further automation, adaptation-related workload of Offline <subscript>weekly</subscript> , Library <subscript>static</subscript> , Library <subscript>progressive</subscript> , and Online <subscript>re-opt</subscript> was expected to increase by 3, 8, 21, and 66 h for 35 fraction treatment courses compared to Offline <subscript>trigger-based</subscript> . The corresponding adaptation-related prolonged treatment times were estimated to be 0, 4, 6, and 29 min/fraction.<br />Conclusion: Online adaptive strategies could approach dosimetric quality of full re-planning at the cost of additional workload and prolonged treatment time compared to the current offline adaptive strategy. Automation needs to play a key role in making more complex adaptive approaches feasible.<br />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.<br /> (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Details

Language :
English
ISSN :
1879-0887
Volume :
201
Database :
MEDLINE
Journal :
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Publication Type :
Academic Journal
Accession number :
39343389
Full Text :
https://doi.org/10.1016/j.radonc.2024.110548