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CBCT-guided evolutive library for cervical adaptive IMRT.

Bastien Rigaud1,2, Antoine Simon1,2, Maxime Gobeli3

  • 1LTSI, Université de Rennes 1, Campus de Beaulieu, Rennes, F-35042, France.

Medical Physics
|February 18, 2018
PubMed
Summary

The novel "Evolutive library adaptive radiation therapy" (ART) strategy improved clinical target volume (CTV) coverage and organ sparing in cervical cancer patients. This personalized approach enhances treatment precision by incorporating cone-beam computed tomography (CBCT) data.

Keywords:
adaptivecervixevaluationradiotherapy

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Area of Science:

  • Radiation oncology
  • Medical imaging
  • Cancer treatment

Background:

  • Adaptive radiation therapy (ART) aims to improve treatment accuracy by adjusting radiation doses based on anatomical changes during treatment.
  • Locally advanced cervical carcinoma (LACC) treatment requires precise radiation delivery to maximize tumor control while minimizing toxicity to surrounding organs.
  • Cone-beam computed tomography (CBCT) enables image-guided radiation therapy (IGRT) by providing real-time anatomical information.

Purpose of the Study:

  • To propose and evaluate an original CBCT-guided "Evolutive library" adaptive radiation therapy (ART) strategy for LACC.
  • To compare the proposed strategy against four other radiotherapy (RT) techniques.
  • To assess the impact of the "Evolutive library ART" on clinical target volume (CTV) coverage and organ at risk (OAR) sparing.

Main Methods:

  • Twenty LACC patients undergoing intensity-modulated radiation therapy (IMRT) were included.
  • Three planning CT scans (empty, intermediate, full bladder) and multiple CBCTs were acquired.
  • Five RT strategies were simulated: Standard RT, internal target volume (ITV)-based RT, mid-treatment replanning (MidTtReplan), pretreatment library ART, and Evolutive library ART.
  • Geometric and dosimetric comparisons were performed using planning target volume (PTV) margins of 7 and 10 mm.

Main Results:

  • The "Evolutive library ART" demonstrated superior CTV geometric coverage by the PTV (98.5% with 10 mm, 96.2% with 7 mm margins).
  • This strategy significantly reduced bowel irradiation compared to other methods.
  • Dosimetric analysis showed a 27% increase in CTV V42.75Gy with "Evolutive library ART" compared to "Standard RT" at 7 mm margins.
  • CTV undercoverage was noted in anterior and superior uterine regions across all strategies.

Conclusions:

  • The "Evolutive library ART" is an effective personalized strategy for LACC, integrating pretreatment libraries with per-treatment CBCT data.
  • It significantly improves CTV coverage and organ sparing, potentially allowing for PTV margin reduction.
  • This approach offers a promising advancement in adaptive radiation therapy for cervical cancer.