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A dosimetric evaluation of IGART strategies for cervix cancer treatment
Institution:1. Australian e-Health Research Centre, Royal Brisbane and Women''s Hospital, Commonwealth Scientific and Industrial Research Organization, Brisbane, Queensland 4029, Australia;2. Department of Radiation Oncology, Liverpool Hospital, Elizabeth Street, Liverpool, New South Wales 2170, Australia;3. Institute of Medical Physics, Sydney University, City Road, Darlington, New South Wales 2008, Australia;4. Centre For Medical Radiation Physics, University of Wollongong, Northfields Avenue, Wollongong, New South Wales 2522, Australia;5. South Western Clinical School, University of New South Wales, Sydney, New South Wales 2170, Australia;6. Royal Brisbane and Women''s Hospital, Butterfield Street, Herston, Queensland 4029, Australia;7. School of Medicine, University of Queensland, 288 Herston Road, Herston, Brisbane, Queensland 4006, Australia;8. University of Western Sydney, Richmond, New South Wales 2753, Australia;9. Ingham Institute for Applied Medical Research, Liverpool Hospital, 1 Campbell Street, Liverpool, New South Wales 2170, Australia;10. Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Edith Street, Waratah, New South Wales 2298, Australia;11. Department of Physics, University of Newcastle, Callaghan, New South Wales 2308, Australia;1. Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, Canada;2. Department of Radiation Oncology, University of Toronto, Canada;3. Institute of Biomaterials and Biomedical Engineering, University of Toronto, Canada;4. Department of Medical Biophysics, University of Toronto, Canada;5. RaySearch Laboratories AB, Stockholm, Sweden;6. Department of Radiation Oncology, Liverpool Hospital, Sydney, Australia;1. Department of Radiation Oncology, Liverpool Hospital, Sydney, Australia;2. Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada;3. Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada;4. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada;5. RaySearch Laboratories AB, Stockholm, Sweden;7. Techna Institute for the Advancement of Technology for Health, Toronto, Ontario, Canada
Abstract:PurposeImage guided adaptive radiotherapy (IGART) strategies can be used to include the temporal aspects of radiotherapy treatment. A dosimetric evaluation of on- and off-line adaptive strategies are done in this study.MethodsA library of equivalent uniform dose (EUD)-based Intensity Modulated Radiotherapy Treatment plans with incrementally increasing clinical target volume (CTV)-to-planning target volume (PTV) margins were developed for 10 patients. Utilizing daily computed tomography (CT) images an on-line strategy using a margin-of-the-day (MOD) concept that selects the best plan from the library was employed. This was compared to an off-line strategy with full analysis of accumulated dose between fractions where dosimetric deviations from the treatment intent triggered plan adaptation. A fixed margin treatment approach was used as benchmark.ResultsUsing fixed margins of <15 mm lead to under-dosages of more than 5 Gy in total delivered dose. The average CTV EUD for the off-line and on-line strategy was 50.0 ± 5.0 Gy and 50.4 ± 2.0 Gy respectively and OAR doses were comparable.ConclusionA fixed margin treatment approach yields a significant probability of CTV under-dosage. Using EUD dose metrics CTV coverage can be restored in both the off-line and on-line adaptive strategies at acceptable OAR dose levels. Considering the workload and time on the treatment machine, the off-line strategy proves to be sufficient and more practical.
Keywords:On-line  Off-line  IGART  Cervix cancer  EUD
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