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• W4381193356 endingPage "045030" @default.
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• W4381193356 abstract "Abstract Objective . Adaptive Radiotherapy (ART) is an emerging technique for treating cancer patients which facilitates higher delivery accuracy and has the potential to reduce toxicity. However, ART is also resource-intensive, Requiring extra human and machine time compared to standard treatment methods. In this analysis, we sought to predict the subset of node-negative cervical cancer patients with the greatest benefit from ART, so resources might be properly allocated to the highest-yield patients. Approach . CT images, initial plan data, and on-treatment Cone-Beam CT (CBCT) images for 20 retrospective cervical cancer patients were used to simulate doses from daily non-adaptive and adaptive techniques. We evaluated the coefficient of determination (R 2 ) between dose and volume metrics from initial treatment plans and the dosimetric benefits to the <?CDATA ${Bowel}{V}_{40{Gy}},$?> <mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML overflow=scroll> <mml:mi mathvariant=italic>Bowel</mml:mi> <mml:msub> <mml:mrow> <mml:mi>V</mml:mi> </mml:mrow> <mml:mrow> <mml:mn>40</mml:mn> <mml:mi mathvariant=italic>Gy</mml:mi> </mml:mrow> </mml:msub> <mml:mo>,</mml:mo> </mml:math> <?CDATA ${Bowel}{V}_{45{Gy}},$?> <mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML overflow=scroll> <mml:mi mathvariant=italic>Bowel</mml:mi> <mml:msub> <mml:mrow> <mml:mi>V</mml:mi> </mml:mrow> <mml:mrow> <mml:mn>45</mml:mn> <mml:mi mathvariant=italic>Gy</mml:mi> </mml:mrow> </mml:msub> <mml:mo>,</mml:mo> </mml:math> <?CDATA ${Bladder}{D}_{{mean}},$?> <mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML overflow=scroll> <mml:mi mathvariant=italic>Bladder</mml:mi> <mml:msub> <mml:mrow> <mml:mi>D</mml:mi> </mml:mrow> <mml:mrow> <mml:mi mathvariant=italic>mean</mml:mi> </mml:mrow> </mml:msub> <mml:mo>,</mml:mo> </mml:math> and <?CDATA ${Rectum}{D}_{{mean}}$?> <mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML overflow=scroll> <mml:mi mathvariant=italic>Rectum</mml:mi> <mml:msub> <mml:mrow> <mml:mi>D</mml:mi> </mml:mrow> <mml:mrow> <mml:mi mathvariant=italic>mean</mml:mi> </mml:mrow> </mml:msub> </mml:math> from adaptive radiotherapy using reduced 3 mm or 5 mm CTV-to-PTV margins. The LASSO technique was used to identify the most predictive metrics for <?CDATA ${Bowel}{V}_{40{Gy}}.$?> <mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML overflow=scroll> <mml:mi mathvariant=italic>Bowel</mml:mi> <mml:msub> <mml:mrow> <mml:mi>V</mml:mi> </mml:mrow> <mml:mrow> <mml:mn>40</mml:mn> <mml:mi mathvariant=italic>Gy</mml:mi> </mml:mrow> </mml:msub> <mml:mo>.</mml:mo> </mml:math> The three highest performing metrics were used to build multivariate models with leave-one-out validation for <?CDATA ${Bowel}{V}_{40{Gy}}.$?> <mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML overflow=scroll> <mml:mi mathvariant=italic>Bowel</mml:mi> <mml:msub> <mml:mrow> <mml:mi>V</mml:mi> </mml:mrow> <mml:mrow> <mml:mn>40</mml:mn> <mml:mi mathvariant=italic>Gy</mml:mi> </mml:mrow> </mml:msub> <mml:mo>.</mml:mo> </mml:math> Main results . Patients with higher initial bowel doses were correlated with the largest decreases in Bowel <?CDATA ${V}_{40{Gy}}$?> <mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML overflow=scroll> <mml:msub> <mml:mrow> <mml:mi>V</mml:mi> </mml:mrow> <mml:mrow> <mml:mn>40</mml:mn> <mml:mi mathvariant=italic>Gy</mml:mi> </mml:mrow> </mml:msub> </mml:math> from daily adaptation (linear best fit R 2 = 0.77 for a 3 mm PTV margin and R 2 = 0.8 for a 5 mm PTV margin). Other metrics had intermediate or no correlation. Selected covariates for the multivariate model were differences in the initial <?CDATA ${Bowel}{V}_{40{Gy}}$?> <mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML overflow=scroll> <mml:mi mathvariant=italic>Bowel</mml:mi> <mml:msub> <mml:mrow> <mml:mi>V</mml:mi> </mml:mrow> <mml:mrow> <mml:mn>40</mml:mn> <mml:mi mathvariant=italic>Gy</mml:mi> </mml:mrow> </mml:msub> </mml:math> and <?CDATA ${Bladder}{D}_{{mean}}$?> <mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML overflow=scroll> <mml:mi mathvariant=italic>Bladder</mml:mi> <mml:msub> <mml:mrow> <mml:mi>D</mml:mi> </mml:mrow> <mml:mrow> <mml:mi mathvariant=italic>mean</mml:mi> </mml:mrow> </mml:msub> </mml:math> using standard versus reduced margins and the initial bladder volume. Leave-one-out validation had an R 2 of 0.66 between predicted and true adaptive <?CDATA ${Bowel}{V}_{40{Gy}}$?> <mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML overflow=scroll> <mml:mi mathvariant=italic>Bowel</mml:mi> <mml:msub> <mml:mrow> <mml:mi>V</mml:mi> </mml:mrow> <mml:mrow> <mml:mn>40</mml:mn> <mml:mi mathvariant=italic>Gy</mml:mi> </mml:mrow> </mml:msub> </mml:math> benefits for both margins. Significance . The resulting models could be used to prospectively triage cervical cancer patients on or off daily adaptation to optimally manage clinical resources. Additionally, this work presents a critical foundation for predicting benefits from daily adaptation that can be extended to other patient cohorts." @default.
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• W4381193356 date "2023-06-30" @default.
• W4381193356 modified "2023-09-23" @default.
• W4381193356 title "Forecasting patient-specific dosimetric benefit from daily online adaptive radiotherapy for cervical cancer" @default.
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• W4381193356 doi "https://doi.org/10.1088/2057-1976/acdf62" @default.
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