Simulated Online Adaptive Magnetic Resonance–Guided Stereotactic Body Radiation Therapy for the Treatment of Oligometastatic Disease of the Abdomen and Central Thorax: Characterization of Potential Advantages
To characterize potential advantages of online-adaptive magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) to treat oligometastatic disease of the non-liver abdomen and central thorax. Ten patients treated with RT for unresectable primary or oligometastatic disease of the non-...
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| Published in | International journal of radiation oncology, biology, physics Vol. 96; no. 5; pp. 1078 - 1086 |
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| Main Authors | , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.12.2016
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0360-3016 1879-355X |
| DOI | 10.1016/j.ijrobp.2016.08.036 |
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| Abstract | To characterize potential advantages of online-adaptive magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) to treat oligometastatic disease of the non-liver abdomen and central thorax.
Ten patients treated with RT for unresectable primary or oligometastatic disease of the non-liver abdomen (n=5) or central thorax (n=5) underwent imaging throughout treatment on a clinical MR image guided RT system. The SBRT plans were created on the basis of tumor/organ at risk (OAR) anatomy at initial computed tomography simulation (PI), and simulated adaptive plans were created on the basis of observed MR image set tumor/OAR “anatomy of the day” (PA). Each PA was planned under workflow constraints to simulate online-adaptive RT. Prescribed dose was 50 Gy/5 fractions, with goal coverage of 95% planning target volume (PTV) by 95% of the prescription, subject to hard OAR constraints. The PI was applied to each MR dataset and compared with PA to evaluate changes in dose delivered to tumor/OARs, with dose escalation when possible.
Hard OAR constraints were met for all PIs based on anatomy from initial computed tomography simulation, and all PAs based on anatomy from each daily MR image set. Application of the PI to anatomy of the day caused OAR constraint violation in 19 of 30 cases. Adaptive planning increased PTV coverage in 21 of 30 cases, including 14 cases in which hard OAR constraints were violated by the nonadaptive plan. For 9 PA cases, decreased PTV coverage was required to meet hard OAR constraints that would have been violated in a nonadaptive setting.
Online-adaptive MRI-guided SBRT may allow PTV dose escalation and/or simultaneous OAR sparing compared with nonadaptive SBRT. A prospective clinical trial is underway at our institution to evaluate clinical outcomes of this technique. |
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| AbstractList | To characterize potential advantages of online-adaptive magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) to treat oligometastatic disease of the non-liver abdomen and central thorax.
Ten patients treated with RT for unresectable primary or oligometastatic disease of the non-liver abdomen (n=5) or central thorax (n=5) underwent imaging throughout treatment on a clinical MR image guided RT system. The SBRT plans were created on the basis of tumor/organ at risk (OAR) anatomy at initial computed tomography simulation (PI), and simulated adaptive plans were created on the basis of observed MR image set tumor/OAR “anatomy of the day” (PA). Each PA was planned under workflow constraints to simulate online-adaptive RT. Prescribed dose was 50 Gy/5 fractions, with goal coverage of 95% planning target volume (PTV) by 95% of the prescription, subject to hard OAR constraints. The PI was applied to each MR dataset and compared with PA to evaluate changes in dose delivered to tumor/OARs, with dose escalation when possible.
Hard OAR constraints were met for all PIs based on anatomy from initial computed tomography simulation, and all PAs based on anatomy from each daily MR image set. Application of the PI to anatomy of the day caused OAR constraint violation in 19 of 30 cases. Adaptive planning increased PTV coverage in 21 of 30 cases, including 14 cases in which hard OAR constraints were violated by the nonadaptive plan. For 9 PA cases, decreased PTV coverage was required to meet hard OAR constraints that would have been violated in a nonadaptive setting.
Online-adaptive MRI-guided SBRT may allow PTV dose escalation and/or simultaneous OAR sparing compared with nonadaptive SBRT. A prospective clinical trial is underway at our institution to evaluate clinical outcomes of this technique. Purpose To characterize potential advantages of online-adaptive magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) to treat oligometastatic disease of the non-liver abdomen and central thorax. Methods and Materials Ten patients treated with RT for unresectable primary or oligometastatic disease of the non-liver abdomen (n=5) or central thorax (n=5) underwent imaging throughout treatment on a clinical MR image guided RT system. The SBRT plans were created on the basis of tumor/organ at risk (OAR) anatomy at initial computed tomography simulation (PI ), and simulated adaptive plans were created on the basis of observed MR image set tumor/OAR “anatomy of the day” (PA ). Each PA was planned under workflow constraints to simulate online-adaptive RT. Prescribed dose was 50 Gy/5 fractions, with goal coverage of 95% planning target volume (PTV) by 95% of the prescription, subject to hard OAR constraints. The PI was applied to each MR dataset and compared with PA to evaluate changes in dose delivered to tumor/OARs, with dose escalation when possible. Results Hard OAR constraints were met for all PIs based on anatomy from initial computed tomography simulation, and all PAs based on anatomy from each daily MR image set. Application of the PI to anatomy of the day caused OAR constraint violation in 19 of 30 cases. Adaptive planning increased PTV coverage in 21 of 30 cases, including 14 cases in which hard OAR constraints were violated by the nonadaptive plan. For 9 PA cases, decreased PTV coverage was required to meet hard OAR constraints that would have been violated in a nonadaptive setting. Conclusions Online-adaptive MRI-guided SBRT may allow PTV dose escalation and/or simultaneous OAR sparing compared with nonadaptive SBRT. A prospective clinical trial is underway at our institution to evaluate clinical outcomes of this technique. To characterize potential advantages of online-adaptive magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) to treat oligometastatic disease of the non-liver abdomen and central thorax. Ten patients treated with RT for unresectable primary or oligometastatic disease of the non-liver abdomen (n=5) or central thorax (n=5) underwent imaging throughout treatment on a clinical MR image guided RT system. The SBRT plans were created on the basis of tumor/organ at risk (OAR) anatomy at initial computed tomography simulation (P ), and simulated adaptive plans were created on the basis of observed MR image set tumor/OAR "anatomy of the day" (P ). Each P was planned under workflow constraints to simulate online-adaptive RT. Prescribed dose was 50 Gy/5 fractions, with goal coverage of 95% planning target volume (PTV) by 95% of the prescription, subject to hard OAR constraints. The P was applied to each MR dataset and compared with P to evaluate changes in dose delivered to tumor/OARs, with dose escalation when possible. Hard OAR constraints were met for all P based on anatomy from initial computed tomography simulation, and all P based on anatomy from each daily MR image set. Application of the P to anatomy of the day caused OAR constraint violation in 19 of 30 cases. Adaptive planning increased PTV coverage in 21 of 30 cases, including 14 cases in which hard OAR constraints were violated by the nonadaptive plan. For 9 P cases, decreased PTV coverage was required to meet hard OAR constraints that would have been violated in a nonadaptive setting. Online-adaptive MRI-guided SBRT may allow PTV dose escalation and/or simultaneous OAR sparing compared with nonadaptive SBRT. A prospective clinical trial is underway at our institution to evaluate clinical outcomes of this technique. PURPOSETo characterize potential advantages of online-adaptive magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) to treat oligometastatic disease of the non-liver abdomen and central thorax.METHODS AND MATERIALSTen patients treated with RT for unresectable primary or oligometastatic disease of the non-liver abdomen (n=5) or central thorax (n=5) underwent imaging throughout treatment on a clinical MR image guided RT system. The SBRT plans were created on the basis of tumor/organ at risk (OAR) anatomy at initial computed tomography simulation (PI), and simulated adaptive plans were created on the basis of observed MR image set tumor/OAR "anatomy of the day" (PA). Each PA was planned under workflow constraints to simulate online-adaptive RT. Prescribed dose was 50 Gy/5 fractions, with goal coverage of 95% planning target volume (PTV) by 95% of the prescription, subject to hard OAR constraints. The PI was applied to each MR dataset and compared with PA to evaluate changes in dose delivered to tumor/OARs, with dose escalation when possible.RESULTSHard OAR constraints were met for all PIs based on anatomy from initial computed tomography simulation, and all PAs based on anatomy from each daily MR image set. Application of the PI to anatomy of the day caused OAR constraint violation in 19 of 30 cases. Adaptive planning increased PTV coverage in 21 of 30 cases, including 14 cases in which hard OAR constraints were violated by the nonadaptive plan. For 9 PA cases, decreased PTV coverage was required to meet hard OAR constraints that would have been violated in a nonadaptive setting.CONCLUSIONSOnline-adaptive MRI-guided SBRT may allow PTV dose escalation and/or simultaneous OAR sparing compared with nonadaptive SBRT. A prospective clinical trial is underway at our institution to evaluate clinical outcomes of this technique. Purpose: To characterize potential advantages of online-adaptive magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) to treat oligometastatic disease of the non-liver abdomen and central thorax. Methods and Materials: Ten patients treated with RT for unresectable primary or oligometastatic disease of the non-liver abdomen (n=5) or central thorax (n=5) underwent imaging throughout treatment on a clinical MR image guided RT system. The SBRT plans were created on the basis of tumor/organ at risk (OAR) anatomy at initial computed tomography simulation (P{sub I}), and simulated adaptive plans were created on the basis of observed MR image set tumor/OAR “anatomy of the day” (P{sub A}). Each P{sub A} was planned under workflow constraints to simulate online-adaptive RT. Prescribed dose was 50 Gy/5 fractions, with goal coverage of 95% planning target volume (PTV) by 95% of the prescription, subject to hard OAR constraints. The P{sub I} was applied to each MR dataset and compared with P{sub A} to evaluate changes in dose delivered to tumor/OARs, with dose escalation when possible. Results: Hard OAR constraints were met for all P{sub Is} based on anatomy from initial computed tomography simulation, and all P{sub As} based on anatomy from each daily MR image set. Application of the P{sub I} to anatomy of the day caused OAR constraint violation in 19 of 30 cases. Adaptive planning increased PTV coverage in 21 of 30 cases, including 14 cases in which hard OAR constraints were violated by the nonadaptive plan. For 9 P{sub A} cases, decreased PTV coverage was required to meet hard OAR constraints that would have been violated in a nonadaptive setting. Conclusions: Online-adaptive MRI-guided SBRT may allow PTV dose escalation and/or simultaneous OAR sparing compared with nonadaptive SBRT. A prospective clinical trial is underway at our institution to evaluate clinical outcomes of this technique. |
| Author | Parikh, Parag Michalski, Jeff Rodriguez, Vivian Zhao, Tianyu Wooten, H. Omar Olsen, Jeffrey R. Kashani, Rojano Green, Olga Bradley, Jeffrey Li, H. Harold Yang, Deshan Mutic, Sasa Hu, Yanle Henke, Lauren Olsen, Lindsey Robinson, Clifford |
| Author_xml | – sequence: 1 givenname: Lauren surname: Henke fullname: Henke, Lauren organization: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri – sequence: 2 givenname: Rojano surname: Kashani fullname: Kashani, Rojano organization: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri – sequence: 3 givenname: Deshan surname: Yang fullname: Yang, Deshan organization: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri – sequence: 4 givenname: Tianyu surname: Zhao fullname: Zhao, Tianyu organization: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri – sequence: 5 givenname: Olga surname: Green fullname: Green, Olga organization: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri – sequence: 6 givenname: Lindsey surname: Olsen fullname: Olsen, Lindsey organization: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri – sequence: 7 givenname: Vivian surname: Rodriguez fullname: Rodriguez, Vivian organization: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri – sequence: 8 givenname: H. Omar surname: Wooten fullname: Wooten, H. Omar organization: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri – sequence: 9 givenname: H. Harold surname: Li fullname: Li, H. Harold organization: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri – sequence: 10 givenname: Yanle surname: Hu fullname: Hu, Yanle organization: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri – sequence: 11 givenname: Jeffrey surname: Bradley fullname: Bradley, Jeffrey organization: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri – sequence: 12 givenname: Clifford surname: Robinson fullname: Robinson, Clifford organization: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri – sequence: 13 givenname: Parag surname: Parikh fullname: Parikh, Parag organization: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri – sequence: 14 givenname: Jeff surname: Michalski fullname: Michalski, Jeff organization: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri – sequence: 15 givenname: Sasa surname: Mutic fullname: Mutic, Sasa organization: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri – sequence: 16 givenname: Jeffrey R. surname: Olsen fullname: Olsen, Jeffrey R. email: Jeffrey.R.Olsen@ucdenver.edu organization: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27742541$$D View this record in MEDLINE/PubMed https://www.osti.gov/biblio/22645731$$D View this record in Osti.gov |
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| Snippet | To characterize potential advantages of online-adaptive magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) to treat oligometastatic... Purpose To characterize potential advantages of online-adaptive magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) to treat... PURPOSETo characterize potential advantages of online-adaptive magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) to treat... Purpose: To characterize potential advantages of online-adaptive magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) to treat... |
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| SubjectTerms | ABDOMEN Abdominal Neoplasms - diagnostic imaging Abdominal Neoplasms - pathology Abdominal Neoplasms - radiotherapy Abdominal Neoplasms - secondary Aged Aged, 80 and over ANATOMY BIOMEDICAL RADIOGRAPHY CHEST CLINICAL TRIALS COMPUTERIZED TOMOGRAPHY Duodenum - diagnostic imaging GY RANGE 10-100 Hematology, Oncology and Palliative Medicine Humans LIVER Magnetic Resonance Imaging, Interventional - methods Middle Aged NEOPLASMS Organs at Risk - diagnostic imaging RADIATION HAZARDS Radiology RADIOLOGY AND NUCLEAR MEDICINE Radiosurgery - methods RADIOTHERAPY Radiotherapy Dosage Radiotherapy Planning, Computer-Assisted - methods SIMULATION Stomach - diagnostic imaging Thoracic Neoplasms - diagnostic imaging Thoracic Neoplasms - pathology Thoracic Neoplasms - radiotherapy Thoracic Neoplasms - secondary Tomography, X-Ray Computed - methods |
| Title | Simulated Online Adaptive Magnetic Resonance–Guided Stereotactic Body Radiation Therapy for the Treatment of Oligometastatic Disease of the Abdomen and Central Thorax: Characterization of Potential Advantages |
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