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• W2757509871 abstract "For nasopharynx cancer (NPC), adaptive radiotherapy (ART) techniques that account for changes in tumor contours may result in improved target coverage and organ-at-risk dosimetry. A robust quantitative method for tracking tumor contour change could facilitate clinical implementation of ART. As manual delineation of primary tumor contours on daily cone beam CT (CBCT) is subjective and time consuming, we evaluated objective surrogates that are amenable to automated assessment. Forty NPC patients treated with intensity modulated radiotherapy (IMRT) and daily CBCT image guidance at our institution between 2013 and 2015 were identified. CBCTs were rigidly registered to the planning CT (pCT) within RayStation v.4.5.2 using the shifts performed at treatment. Three contours were propagated from pCT onto each CBCT: (1) primary gross tumor volume (GTV); (2) a 5mm isotropic expansion of GTV (GTV+5mm); (3) an anatomically defined box delineating the boundaries of the nasopharynx (NP_box). Within each contour, the air column volume (ACV) was defined using a Hounsfield Unit threshold of –450. Change in ACV from pCT (DACV) was evaluated for potential use as surrogate for change in GTV size. T-category was T1-2 in 12 (30%) and T3-4 in 28 (70%) patients. Median primary GTV size was 19 cm3 (IQR: 12-40). Epstein Barr Encoded RNA (EBER) in situ hybridization was positive in 32 (80%) patients. Concurrent chemotherapy was delivered in 35 (87.5%) patients. Median number of evaluable CBCTs per patient was 35 (range: 30-35). ACV variability from sequential CBCTs was highest within the NP_box contour, and a decrease of ACV occurring in a subset of patients over the first 2 fractions could not be reliably detected within the GTV-derived contour; thus, the GTV+5mm contour was used for subsequent analysis. Following the initial decrease in ACV, ACV increased over the remainder of the treatment course in all patients, becoming statistically significant by fraction 4 (paired t-test p<0.001 for each). The majority of change occurred prior to the 20th fraction. By the 10th, 20th, and final fraction, median DACV was 1.3 cm3 (IQR: 0.3-2.4), 2.2 cm3 (IQR: 1.4-4.6), and 2.8 cm3 (IQR: 1.9-5.6), corresponding to 6% (IQR: 2-10%), 12% (IQR: 7-27%), and 15% (IQR: 8-27%) of the initial GTV size, respectively. Larger tumors displayed a greater DACV at the 20th (Pearson R=0.41, p=0.009) and final fraction (R=0.48, p=0.001); however, as a percentage of initial GTV size, T1-2 tumors displayed a greater DACV compared with T3-4 tumors at the 20th(31±16% vs. 11±8%, p<0.001) and final fraction (34±13% vs. 13±9%, p<0.001). An air column surrogate of GTV change can be used as one objective and automated assessment on daily CBCTs for NPC patients treated with IMRT. The change in air column volume correlates with initial GTV size and T-category. The utility of tracking surrogates of GTV change for ART deserves further study." @default.
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• W2757509871 date "2017-10-01" @default.
• W2757509871 modified "2023-10-16" @default.
• W2757509871 title "Automated Assessment of Nasopharynx Cancer GTV Change on Daily Cone Beam CT" @default.
• W2757509871 doi "https://doi.org/10.1016/j.ijrobp.2017.06.2153" @default.
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