Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2025
First online real-time motion-including prostate and bladder dose reconstruction during prostate radiotherapy.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Klucznik Karolina, Ravkilde Thomas, Skouboe Simon, Keall Paul, Happersett Laura, Pham Hai, Leong Brian, Zhang Pengpeng, Tang Grace, Poulsen Per R
Аннотация
BACKGROUND AND MOTIVATION: Organ motion can distort prostate radiotherapy doses. This study presents the first real-time calculation of the motion-induced dose distortions performed online during prostate radiotherapy.
METHODS: Twenty patients were treated with stereotactic prostate radiotherapy of 35 Gy or 40 Gy in 5 fractions using intrafractional image guidance for real-time prostate localization and patient repositioning upon prostate misalignments exceeding 1.5 mm. In-house developed software performed motion-including prostate and bladder dose reconstruction during treatment. The reconstructed doses were retrospectively validated against a clinical treatment planning system (TPS) where motion was encoded in treatment plans as multiple 3D isocenter shifts. Hypothetical doses delivered without intra-treatment repositioning were reconstructed post-treatment for comparison to illustrate how the dose reconstruction allows easy assessment of the effectiveness of the used motion mitigation method.
RESULTS: Dose reconstruction was performed for 91 fractions either online during treatment (n = 41) or retrospectively using recorded motion (n = 50). The real-time calculated doses (calculated by the in-house software using a simplified algorithm) agreed with TPS calculations with mean (±std) differences of 0.1 % (±0.9 %) for clinical target volume (CTV) D95% and 0.2 % (±0.2 %) for bladder V36Gy. The mean time per online dose-reconstruction (±std) was 336 ± 86 ms, proving the real-time applicability of the proposed method. The average (±std) motion-induced dose distortions for individual fractions with intrafractional image guidance were -0.5 % (±1.0 %) for CTV D95% and +0.1 % (±0.5 %) for bladder V36Gy for individual fractions. Accumulated across all fractions of each patient, these deviations decreased to 0.0 % (±0.7 %) for the CTV and +0.1 % (±0.2 %) for the bladder. In contrast, without intratreatment repositioning, deviations would have been -1.3 % (±5.0 %) for CTV D95% and +0.5 % (±1.5 %) for bladder V36Gy, with individual fractions exhibiting clinically unacceptable CTV D95% decreases of up to 42.5 %.
CONCLUSION: This study marks the first clinical realization of real-time motion-including dose reconstruction for both target and organ-at-risk structures paving the way for real-time dose-guided radiotherapy.
METHODS: Twenty patients were treated with stereotactic prostate radiotherapy of 35 Gy or 40 Gy in 5 fractions using intrafractional image guidance for real-time prostate localization and patient repositioning upon prostate misalignments exceeding 1.5 mm. In-house developed software performed motion-including prostate and bladder dose reconstruction during treatment. The reconstructed doses were retrospectively validated against a clinical treatment planning system (TPS) where motion was encoded in treatment plans as multiple 3D isocenter shifts. Hypothetical doses delivered without intra-treatment repositioning were reconstructed post-treatment for comparison to illustrate how the dose reconstruction allows easy assessment of the effectiveness of the used motion mitigation method.
RESULTS: Dose reconstruction was performed for 91 fractions either online during treatment (n = 41) or retrospectively using recorded motion (n = 50). The real-time calculated doses (calculated by the in-house software using a simplified algorithm) agreed with TPS calculations with mean (±std) differences of 0.1 % (±0.9 %) for clinical target volume (CTV) D95% and 0.2 % (±0.2 %) for bladder V36Gy. The mean time per online dose-reconstruction (±std) was 336 ± 86 ms, proving the real-time applicability of the proposed method. The average (±std) motion-induced dose distortions for individual fractions with intrafractional image guidance were -0.5 % (±1.0 %) for CTV D95% and +0.1 % (±0.5 %) for bladder V36Gy for individual fractions. Accumulated across all fractions of each patient, these deviations decreased to 0.0 % (±0.7 %) for the CTV and +0.1 % (±0.2 %) for the bladder. In contrast, without intratreatment repositioning, deviations would have been -1.3 % (±5.0 %) for CTV D95% and +0.5 % (±1.5 %) for bladder V36Gy, with individual fractions exhibiting clinically unacceptable CTV D95% decreases of up to 42.5 %.
CONCLUSION: This study marks the first clinical realization of real-time motion-including dose reconstruction for both target and organ-at-risk structures paving the way for real-time dose-guided radiotherapy.