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• W4387207360 abstract "Daily adaptive therapy (AdaptT) for locally advanced lung cancer has been an intriguing field with the adoption of cone beam CT (CBCT). We have utilized AdaptT for lung cancer. In this workflow, contours for targets and organs at risk from the original CT simulation dataset are deformed and registered to the CBCT for each fraction. A physicist reviews and edits the deformed contours online without MD presence and a new plan is treated daily. Treating physicians are required to attend 1 fraction per week. We sought to evaluate the accuracy of these contours for targets and OARs in comparison to a thoracic physician contouring offline with the same CBCT dataset. The impetus of this study was to evaluate the model of physics directed contouring and ensure that gross tumor volume (GTV) misses are not occurring during treatment, defined as Planning Target Volumes (PTV's) derived from AdaptT failing to encompass the GTV redrawn offline by the physician.Six consecutive patients were treated from 2021-2022 with AdaptT utilizing processes as described above. One CBCT per week was re-contoured by a physician for 5-6 CBCT's per case. The GTVs, heart, and lungs were redrawn without registration. The physician was blinded to the structures approved for that fraction and from clinical information outside of the CT simulation data. The clinical target volume expansions were 5 mm shaved from normal tissue barriers and a uniform 5 mm expansion to form the PTV. The Dice Similarity Coefficient (DSE), mean surface distance (MSD), 95th percentile Hausdorff distance (95HD) for contours were calculated and the True Positive Fraction (TPF) of the redrawn GTVs within the treated PTVs were calculated.Thirty CBCTs from 6 patients were contoured. The TPF was 1 for each redrawn GTV, indicating each GTV drawn by the physician offline would have been encompassed within the PTV for treatment. The median 95HF for the targets was below 5 mm (Table 1) and the MSD for targets was close to 1.07 mm. The DSC for Heart and Lungs approached 1.0, indicating close similarity. The average time the physician spent on contouring was 9.8 minutes compared to 9.6 minutes with AdaptT.All redrawn GTVs were within the treated PTV and there was close agreement of normal structures. We evaluated the current model employing daily physics overview with weekly physician input and it appears safe and feasible. Further prospective study is needed to standardize comparison of contour quality and validate clinical outcomes of this approach." @default.
• W4387207360 created "2023-09-30" @default.
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• W4387207360 date "2023-10-01" @default.
• W4387207360 modified "2023-10-17" @default.
• W4387207360 title "Offline Verification of Daily Adaptive Therapy for Locally Advanced Lung Cancer" @default.
• W4387207360 doi "https://doi.org/10.1016/j.ijrobp.2023.06.2170" @default.
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