Comparison of adaptive radiotherapy techniques for external radiation therapy of canine bladder cancer

Daily bladder variations make it difficult to utilize standard radiotherapy as a primary treatment option for muscle-invasive bladder cancer. Our purpose was to develop a model comparing dose distributions of image-guided and adaptive radiotherapy (ART) techniques for canine bladder cancer. Images were obtained retrospectively from cone-beam computed tomography (CBCT) scans used for daily positioning of four dogs undergoing fractionated image-guided radiotherapy (IGRT). Four different treatment plans were modeled for each dog, and dosimetric data were compared. Two plans were developed using planning target volumes based on planning computed tomography (CT) bladder volume. These plans then used bony anatomy or soft tissue anatomy for daily positioning and dosimetric modeling. The third plan type was a hybrid IGRT and ART technique utilizing a library of premade anisotropic planning target volumes using bladder wall motion data and selection of a "plan-of-the-day" determined from positioning CBCT bladder volumes. The fourth plan was an ART technique that constructed a new planning target volume each day based on daily bladder volume as determined by pretreatment CBCT. Dose volume histograms were generated for each plan type and dose distribution for the bladder and rectum were compared between plan types. Irradiated rectal volume decreased and irradiated bladder volume increased as plan conformality increased. ART provided the greatest rectal sparing, with lowest irradiated rectal volume (P < 0.001), and largest bladder volume receiving 95% of the prescription dose (P < 0.001). In our model, adaptive radiotherapy techniques for canine bladder cancer showed significant reduction in rectal volume irradiated when compared to nonadaptive techniques, while maintaining appropriate bladder coverage.