Evaluation of resource burden for bladder adaptive strategies: A timing study

Area of Science:

• Radiation Oncology
• Medical Physics
• Cancer Treatment

Background:

• Interfraction bladder motion necessitates adaptive radiotherapy strategies.
• Reoptimization (ReOpt) shows dosimetric superiority over Plan of the Day (POD) and Patient-specific PTV (PS-PTV).
• Clinical feasibility of adaptive strategies depends on resource burden assessment.

Purpose of the Study:

• To assess and compare the resource burden of three adaptive radiotherapy strategies: POD, PS-PTV, and ReOpt.
• To evaluate the feasibility of implementing these strategies in a clinical setting.

Main Methods:

• Simulated POD, PS-PTV, and ReOpt strategies offline for 10 bladder cancer patients.
• Identified and categorized additional activities required for each adaptive strategy compared to non-adaptive radiotherapy.
• Measured the time consumed for each strategy by an experienced observer.

Main Results:

• PS-PTV required 14.4 minutes, POD required 49.1 minutes, and ReOpt required 248.5 minutes.
• PS-PTV activities could be performed without patient presence or treatment room time.
• ReOpt was the most time-intensive, potentially increasing patient treatment time and decreasing capacity.

Conclusions:

• ReOpt, while dosimetrically superior, presents a significant resource burden potentially hindering clinical adoption.
• PS-PTV is the least resource-intensive adaptive strategy, suggesting greater clinical feasibility.
• Balancing dosimetric benefits with resource implications is crucial for selecting adaptive radiotherapy strategies.