Technical innovations & patient support in radiation oncology · 2025
Improved PTV coverage and OAR sparing with stereotactic MRI-guided online adaptive radiotherapy with elective fields in pancreatic cancer.
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Konnerth Dinah, Hojo Hidehiro, Fuchs Frederik, Shouman Mohamed A, Dehelean Diana-Coralia, Gaasch Aurélie, Walter Franziska, Eze Chukwuka, Marschner Sebastian N, Mansoorian Sina, Maier Sebastian H, da Silva Mendes Vanessa, Hofmaier Jan, Niyazi Maximilian, Belka Claus, Corradini Stefanie, Rogowski Paul
Аннотация
PURPOSE: Ablative stereotactic radiotherapy for pancreatic ductal adenocarcinoma (PDAC) is limited by adjacent radiosensitive organs at risk (OAR) that exhibit significant daily positional variability. This study aims to investigate the benefit of stereotactic MRI-guided online adaptive radiotherapy (SMART) with elective fields on target coverage and OAR dose sparing in patients with PDAC.
METHODS: We retrospectively analysed 62 consecutive PDAC patients treated with SMART between 2020-2024, totaling 310 fractions. For each fraction, a non-adapted plan (PLANPREDICT) was compared to its online-adapted counterpart (PLANREOPTIMIZED). We assessed planning target volume (PTV) coverage and OAR constraints. Plan-adaptation was classified as "useful" when the PLANREOPTIMIZED met all objectives or improved PTV coverage or OAR sparing by ≥ 10 %, as "futile" when PLANREOPTIMIZED failed to meet or markedly improve objectives, and as "not necessary" when PLANPREDICT already met all objectives.
RESULTS: Prescribed doses were 40 Gy (71 %) and 33 Gy (29 %) over five fractions. A simultaneous integrated boost approach was used in 47 % of patients. The PLANPREDICT met all planning goals in 1 % of fractions, which increased to 72 % with PLANREOPTIMIZED. Adaptation yielded significant improvements in PTV coverage (p < 0.001) and reductions in V33Gy for stomach (median 0.26 cc vs. 0.01 cc), duodenum (median 1.08 cc vs. 0.07 cc) and bowel (median 2.04 cc vs. 0.06 cc), all p < 0.001. Adaptation was deemed useful in 305 (98 %), not necessary in 4 (1 %) and futile in 1 fraction (0.3 %).
CONCLUSION: For the vast majority of PDAC patients treated with stereotactic radiotherapy with elective fields daily online adaptation enhances target coverage and OAR sparing.
METHODS: We retrospectively analysed 62 consecutive PDAC patients treated with SMART between 2020-2024, totaling 310 fractions. For each fraction, a non-adapted plan (PLANPREDICT) was compared to its online-adapted counterpart (PLANREOPTIMIZED). We assessed planning target volume (PTV) coverage and OAR constraints. Plan-adaptation was classified as "useful" when the PLANREOPTIMIZED met all objectives or improved PTV coverage or OAR sparing by ≥ 10 %, as "futile" when PLANREOPTIMIZED failed to meet or markedly improve objectives, and as "not necessary" when PLANPREDICT already met all objectives.
RESULTS: Prescribed doses were 40 Gy (71 %) and 33 Gy (29 %) over five fractions. A simultaneous integrated boost approach was used in 47 % of patients. The PLANPREDICT met all planning goals in 1 % of fractions, which increased to 72 % with PLANREOPTIMIZED. Adaptation yielded significant improvements in PTV coverage (p < 0.001) and reductions in V33Gy for stomach (median 0.26 cc vs. 0.01 cc), duodenum (median 1.08 cc vs. 0.07 cc) and bowel (median 2.04 cc vs. 0.06 cc), all p < 0.001. Adaptation was deemed useful in 305 (98 %), not necessary in 4 (1 %) and futile in 1 fraction (0.3 %).
CONCLUSION: For the vast majority of PDAC patients treated with stereotactic radiotherapy with elective fields daily online adaptation enhances target coverage and OAR sparing.