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Adaptive plan selection vs. re-optimisation in radiotherapy for bladder cancer: a dose accumulation comparison
Anne Vestergaard1, Ludvig Paul Muren, Jimmi Søndergaard
1Department of Medical Physics, Aarhus University Hospital, Aarhus C, Denmark.
Summary
Adaptive radiotherapy (ART) significantly spares normal tissue in bladder cancer treatment. Daily plan re-optimization (ReOpt) showed superior results compared to plan selection (PlanSelect) and non-adaptive radiotherapy.
Area of Science:
- Radiation oncology
- Medical physics
Background:
- Urinary bladder cancer patients exhibit significant inter-fractional variations in bladder volume.
- These variations make adaptive radiotherapy (ART) a suitable treatment strategy.
Purpose of the Study:
- To compare the normal tissue sparing capabilities of two ART strategies: daily plan selection (PlanSelect) and daily plan re-optimization (ReOpt).
Main Methods:
- Seven bladder cancer patients were enrolled.
- PlanSelect involved selecting the best plan from a pre-generated library based on daily cone-beam CT (CBCT).
- ReOpt involved daily re-optimization of treatment plans using CBCT data and deformable image registration (DIR) for contour propagation.
Main Results:
- Both ART strategies achieved considerable normal tissue sparing compared to non-adaptive radiotherapy.
- ReOpt demonstrated superior sparing, reducing the volume receiving 95% of the prescribed dose (V95) to 41% (range 33-50%) compared to 66% (range 48-100%) for PlanSelect.
- Significant dose reduction to organs at risk was observed with ReOpt.
Conclusions:
- ART offers substantial normal tissue sparing for bladder cancer patients.
- Daily adaptive re-optimization (ReOpt) is a highly effective strategy for enhancing normal tissue sparing in bladder irradiation.
