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Prospective Study Delivering Simultaneous Integrated High-dose Tumor Boost (≤70 Gy) With Image Guided Adaptive
Shaista Hafeez1, Karole Warren-Oseni2, Helen A McNair1
1The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom.
Summary
Image guided adaptive radiation therapy (IGART) with intensity modulated radiation therapy (IMRT) is a feasible approach for delivering a simultaneous integrated tumor boost to 70 Gy. This method shows acceptable toxicity and will be further evaluated in a randomized trial.
Area of Science:
- Radiation Oncology
- Medical Physics
- Oncology
Background:
- Image guided adaptive radiation therapy (IGART) allows for precise tumor targeting and normal tissue sparing.
- Intensity modulated radiation therapy (IMRT) enables dose escalation for improved tumor coverage.
- Individualized treatment planning is crucial for optimizing radiation therapy outcomes.
Purpose of the Study:
- To evaluate the feasibility and toxicity of IGART using IMRT for delivering a simultaneous integrated tumor boost (SITB) to 70 Gy.
- To assess the impact of IGART on tumor coverage and normal bladder tissue sparing.
- To determine the potential for dose escalation in radiation therapy for bladder cancer.
Main Methods:
- A library of 3 IMRT plans (small, medium, large) was created based on planning CT scans.
- Treatment involved a "plan of the day" approach with weekly cone beam CT (CBCT) for intrafraction assessment.
- Patients received whole bladder irradiation to 52 Gy and tumor boost to 70 Gy in 32 fractions.
Main Results:
- 18 patients completed 70 Gy; 2 patients had dose reductions due to toxicity or treatment course.
- Weekly CBCT scans evaluated intrafraction filling, showing a significant decrease from week 1 to week 5/6 (P=.002).
- Mean tumor boost D98 was 97.07%, and bladder D98 was 99.97% on post-treatment CBCT; no muscle-invasive recurrences observed at median 19-month follow-up.
Conclusions:
- IGART with IMRT for SITB to 70 Gy is feasible and demonstrates acceptable toxicity.
- The technique allows for precise dose delivery, improving tumor coverage and sparing normal tissues.
- Results support further evaluation of this IGART approach in a randomized clinical trial.
