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Adaptive prostate IGRT combining online re-optimization and re-positioning: a feasibility study.

Taoran Li¹, Danthai Thongphiew, Xiaofeng Zhu

¹Department of Radiation Oncology, Duke University Medical Centre, Durham, NC, USA. taoran.li@duke.edu

Physics in Medicine and Biology

|February 3, 2011

Summary

Adaptive image-guided radiation therapy (AIGRT) improves prostate cancer treatment by integrating re-optimization and re-positioning. This approach ensures reliable daily target coverage and better organ sparing compared to existing methods.

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Area of Science:

Radiation Oncology
Medical Physics
Image-Guided Therapy

Background:

Inter-fractional organ motion and deformation in prostate radiation therapy challenge daily dose delivery.
Current clinical corrections include off-line re-optimization and online re-positioning.

Purpose of the Study:

To introduce and evaluate an adaptive image-guided radiation therapy (AIGRT) scheme.
AIGRT integrates off-line re-optimization and online re-positioning in an anatomy-driven manner.

Main Methods:

AIGRT selects the best plan from a pool (original CT plan + re-optimized plans) for daily treatment.
If no suitable plan is found, AIGRT re-optimizes the CT plan for the current anatomy and adds it to the pool.
The scheme was evaluated against daily re-optimization and online re-positioning using simulated treatment courses for 18 patients.

Main Results:

AIGRT demonstrated reliable daily target coverage comparable to daily re-optimization and superior to re-positioning alone.
AIGRT provided improved sparing of organs at risk (OAR) compared to re-positioning.
Simulations showed AIGRT's efficiency in integrating re-optimization into current re-positioning-based IGRT workflows.

Conclusions:

AIGRT offers significant dosimetric benefits, including enhanced target coverage and OAR sparing.
The AIGRT scheme provides an efficient method for adaptive radiation therapy in prostate cancer treatment.
AIGRT effectively combines re-optimization and re-positioning strategies for improved treatment accuracy and efficiency.