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Online adaptive replanning method for prostate radiotherapy.

Ergun E Ahunbay1, Cheng Peng, Shannon Holmes

  • 1Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA. eahunbay@mcw.edu

International Journal of Radiation Oncology, Biology, Physics
|April 6, 2010
PubMed
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An adaptive replanning technique, segment aperture morphing (SAM) and segment weight optimization (SWO), improves prostate cancer radiotherapy by enhancing target coverage and organ sparing. This online method is fast and effective for interfraction variations.

Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Cancer Treatment

Background:

  • Interfraction variations in prostate cancer radiotherapy can compromise treatment efficacy.
  • Adaptive replanning techniques aim to correct for these daily anatomical changes.
  • Current methods often rely on margins or full re-planning, which can be time-consuming.

Purpose of the Study:

  • To evaluate an adaptive replanning technique combining segment aperture morphing (SAM) and segment weight optimization (SWO) for prostate cancer radiotherapy.
  • To assess the technique's ability to account for interfraction variations.
  • To compare the dosimetric benefits of this online replanning method against standard repositioning protocols.

Main Methods:

  • The SAM+SWO adaptive replanning scheme was applied to daily CT images of 10 prostate cancer patients undergoing radiotherapy.

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  • Dose distributions from SAM+SWO were compared to those from patient repositioning with standard (5 mm, 3 mm) and reduced (2 mm) planning target volume (PTV) margins.
  • Full reoptimization based on daily CT images was also used as a comparison point.

    • Main Results:

    • The SAM+SWO online replanning significantly improved target coverage (13% increase in minimum prostate dose) compared to repositioning with a reduced PTV margin.
    • Organ sparing was improved (13% decrease in generalized equivalent uniform dose of the rectum) compared to repositioning with a regular PTV margin.
    • The online replanning process took an average of 6 ± 2 minutes.

    Conclusions:

    • The proposed SAM+SWO online replanning method effectively addresses interfraction variations in prostate radiotherapy.
    • The technique offers significant dosimetric benefits with a clinically acceptable time frame (5-10 minutes).
    • This adaptive replanning scheme is being implemented for clinical use in prostate radiotherapy.