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Huang, Y.* ; Wang, H.* ; Li, C.* ; Hu, Q.* ; Liu, H.* ; Deng, J.* ; Li, W.B. ; Wang, R.* ; Wu, H.* ; Zhang, Y.*

A preliminary simulation study of dose-guided adaptive radiotherapy based on Halcyon MV cone beam CT images with retrospective data from a phase II clinical trial.

Front. Oncol. 10:574889 (2020)
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Open Access Gold
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Background and purpose:To evaluate the feasibility of dose-guided adaptive radiotherapy (ART) based on deformable image registration (DIR) using fractional megavoltage cone-beam CT (MVCBCT) images from Halcyon system that uses identical beams for treatment and imaging and to retrospectively investigate the influence of anatomic changes on target coverage and organ-at-risk (OAR) sparing across various tumor sites. Materials and Methods:Four hundred twenty-two MVCBCT images from 16 patients (three head and neck, seven thoracic, three abdominal, and three pelvic cases) treated in a phase II clinical trial for Halcyon were selected. DIR between the planning CT and daily MVCBCT image was implemented by Velocity software to create pseudo CT. To investigate the accuracy of dose calculation on pseudo CT, three evaluation patients with rescanned CT and adaptive plans were selected. Dose distribution of adaptive plans calculated on pseudo CT was compared with that calculated on the rescanned planning CT on the three evaluation patients. To investigate the impact of inter-fractional anatomic changes on target dose coverage and dose to OARs of the 16 patients, fractional dose was calculated and accumulated incrementally based on deformable registration between planning CT and daily MVCBCT images. Results:Passing rates using 3 mm/3%/10% threshold local gamma analysis were 93.04, 96.00, and 91.68%, respectively, for the three evaluation patients between the reconstructed dose on pseudo CT (MVCBCT) and rescanned CT, where accumulated dose deviations of over 97% voxels were smaller than 0.5 Gy. Planning target volume (PTV) D95% and D90% (the minimum dose received by at least 95/90% of the volume) of the accumulated dose could be as low as 93.8 and 94.5% of the planned dose, respectively. OAR overdose of various degrees were observed in the 16 patients relative to the planned dose. In most cases, OARs' dose volume histogram (DVH) lines of accumulated and planned dose were very close to each other if not overlapping. Among cases with visible deviations, the differences were bilateral without apparent patterns specific to tumor sites or organs. Conclusion:As a confidence building measure, this simulation study suggested the possibility of ART for Halcyon based on DIR between planning CT and MVCBCT. Preliminary clinical data suggested the benefit of patient-specific dose reconstruction and ART to avoid unacceptable target underdosage and OAR overdosage.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Halcyon ; Megavoltage Cone-beam Ct ; Deformable Image Registration ; Adaptive Radiotherapy ; Dose Reconstruction; Intensity-modulated Radiotherapy; Megavoltage Computed-tomography; Deformable Registration; Radiation-therapy; Tumor Volumes; Head; Tomotherapy; Accuracy; Cancer; Imrt
ISSN (print) / ISBN 2234-943X
e-ISSN 2234-943X
Quellenangaben Volume: 10, Issue: , Pages: , Article Number: 574889 Supplement: ,
Publisher Frontiers
Publishing Place Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
Reviewing status Peer reviewed
Grants Beijing Municipal Administration of Hospitals Incubating Program
Capital's Funds for Health Improvement and Research
National Natural Science Foundation of China
Fundamental Research Funds for the Central Universities/Peking University Clinical Medicine Plus X - Young Scholars Project
UICC Technical Fellowship
Peking University Health Science Center Medical Education Research Funding Project
Ministry of Education Science and Technology Development Center
Sichuan Science and Technology Program
National Key R&D Program of China