☆ 4.7 Article

Comparative dosimetry of three-phase adaptive and non-adaptive dose-painting IMRT for head-and-neck cancer

RADIOTHERAPY AND ONCOLOGY (2014)

Journal

RADIOTHERAPY AND ONCOLOGY

Volume 111, Issue 3, Pages 348-353

Publisher

ELSEVIER IRELAND LTD

DOI: 10.1016/j.radonc.2014.02.017

Keywords

Adaptive radiotherapy; Deformable image registration; Dose summation; IMRT; Dose-painting; Head-and-neck cancer

Funding

Agency for Innovation by Science and Technology, Applied Biomedical Research [100774]
Foundation against Cancer [2010-194]
ABAS (Elekta CMS Software, Maryland Heights, MO)

Ask authors/readers for more resources

Protocol

Community support

Reagent

Community support

Abstract

Purpose: The anatomical changes, which occur during the radiotherapy treatment for head-and-neck cancer, may compromise the effectiveness of the treatment. This study compares dosimetrical effects of adaptive (ART) and non-adaptive (RT) dose-painted radiotherapy. Materials and methods: For 10 patients, three treatment phases were preceded by a planning PET/CT scan. In ART, phases II and III were planned using PET/CT2 and PET/CT3, respectively. In RT, phases II and III were planned on PET/CT1 and recalculated on PET/CT2 and PET/CT3. Deformable image co-registration was used to sum the dose distributions and to propagate regions-of-interest (ROIs) drawn on PET/CT1 to PET/CT2, PET/CT3 and a last-treatment-day CT-scan. Results: Re-adjusted dose-painting ART provided higher minimum and lower maximum doses in target ROIs in comparison to RT. On average, ART reduced the parotids' median dose and swallowing structures mean dose by 4.6-7.1% (p > 0.05) and 3% (p = 0.06), respectively. Dose differences for targets were from -1.6% to 6.6% and for organs-at-risk from -7.1% to 7.1%. Analysis of individual patient data showed large improvements of ROI dose/volume metrics by ART, reaching a 24.4% minimum-dose increase in the elective neck planning target volume and 21.1% median-dose decrease in swallowing structures. Conclusion: Compared to RT, ART readjusts dose-painting, increases minimum and decreases maximum doses in target volumes and improves dose/volume metrics of organs-at-risk. The results favored the adaptive strategy, but also revealed considerable heterogeneity in patient-specific benefit. Reporting population-average effects underestimates the patient-specific benefits of ART. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Authors

I am an author on this paper

Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.7

Not enough ratings

Secondary Ratings

Novelty

Significance

Scientific rigor

Rate this paper

Evaluating the Quality of Patient-Specific Deformable Image Registration in Adaptive Radiotherapy Using a Digitally Enhanced Head and Neck Phantom

Elisabetta Cagni, Andrea Botti, Matteo Orlandi, Marco Galaverni, Cinzia Iotti, Mauro Iori, Geraint Lewis, Emiliano Spezi

Summary: This paper presents a deformable image registration-based method for the quality assurance of head and neck adaptive radiotherapy using digitally post-processed anthropomorphic phantom image datasets. The main finding is that spatial and dose errors depend on the magnitude of deformation and the gradient of the dose distribution. Accurate and efficient patient-specific deformable image registration validation methodology is not yet established and there is a need to develop suitable tools for this purpose. A novel methodology was developed to evaluate the quality of computed tomography (CT) and on-board cone-beam CT (CBCT) image registrations, and the method showed the ability to quantify spatial errors and assess their dose impact.

APPLIED SCIENCES-BASEL (2022)