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A case study for online plan adaptation using helical tomotherapy.

Christopher E Neilson1, Slav Yartsev

  • 1London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.

Journal of Medical Physics
|May 5, 2012
PubMed
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Helical tomotherapy enables adaptive radiotherapy planning by using daily imaging to adjust treatment. This study shows adapting plans can reduce rectal dose while maintaining target coverage in bladder cancer patients.

Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Oncologic Imaging

Background:

  • Helical tomotherapy offers daily megavoltage computed tomography (MVCT) imaging for precise patient setup verification.
  • Increasingly complex radiotherapy plans with steep dose gradients necessitate adaptation to account for anatomical changes.
  • Inter-fraction anatomical variations can compromise accurate dose delivery to the target volume.

Purpose of the Study:

  • To evaluate the potential of tomotherapy's adaptive planning option in bladder cancer treatment.
  • To compare dose distributions between original, delivered, and adapted plans using daily MVCT data.
  • To assess the impact of adaptation on rectal and planning target volume (PTV) doses.

Main Methods:

  • Thirty adapted treatment plans were generated for a bladder cancer patient with significant anatomical variations.
Keywords:
Adaptive radiation therapybladder cancerreplanning

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  • Adaptations were based on contours derived from daily MVCT images acquired during helical tomotherapy.
  • Dose metrics for the rectum and two PTVs were compared across the original plan, actual delivered dose, and simulated adapted plans.

    • Main Results:

    • Adaptive planning simulations demonstrated a reduction in rectal dose (35% and 50% volume) compared to non-adapted plans.
    • Equivalent dose to the planning target volumes (PTVs) was maintained with the adapted plans.
    • While online adaptation is currently time-intensive, it shows promise for improving radiotherapy efficacy.

    Conclusions:

    • Adaptive helical tomotherapy planning can potentially spare organs at risk, such as the rectum, in bladder cancer patients.
    • Maintaining target dose coverage is achievable with adaptive strategies.
    • Further development is needed to overcome the time constraints of online adaptation for routine clinical use.