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Treatment plan optimisation for reirradiation.

Louise Murray1, Christopher Thompson2, Christopher Pagett2

  • 1Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Department of Clinical Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology
|February 22, 2023
PubMed
Summary
This summary is machine-generated.

The STRIDeR tool offers a clinically viable pathway for re-irradiation planning, improving treatment decisions by considering past doses and anatomical changes. This radiobiology-guided approach enhances organ at risk evaluation for better patient outcomes.

Keywords:
Deformable image registrationEQD2RadiobiologyRe-irradiationTreatment planning

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Radiotherapy Planning

Background:

  • Re-irradiation planning requires accounting for cumulative dose, fractionation, tissue recovery, and anatomical changes.
  • Existing methods for re-irradiation planning can be laborious and may not fully integrate radiobiological principles.
  • A clinically viable pathway within a commercial treatment planning system (TPS) is needed to standardize and improve re-irradiation decisions.

Purpose of the Study:

  • To develop and present the workflow and technical solutions for the STRIDeR (Support Tool for Re-Irradiation Decisions guided by Radiobiology) pathway.
  • To integrate a clinically viable re-irradiation planning pathway into a commercial TPS.
  • To account for previously delivered dose, fractionation effects, tissue recovery, and anatomical changes in re-irradiation planning.

Main Methods:

  • Implemented the STRIDeR pathway in RayStation (version 9B DTK) using original dose distributions as background dose.
  • Applied organ at risk (OAR) planning objectives in equivalent dose in 2 Gy fractions (EQD2) cumulatively.
  • Optimized re-irradiation plans voxel-by-voxel in EQD2, employing various image registration techniques for anatomical changes.
  • Evaluated the workflow using data from 21 patients undergoing pelvic Stereotactic Ablative Radiotherapy (SABR) re-irradiation.

Main Results:

  • The STRIDeR pathway generated clinically acceptable re-irradiation plans in 20 out of 21 cases.
  • Compared to standard manual planning, STRIDeR required less constraint relaxation or allowed for higher re-irradiation doses in 3 cases.
  • Demonstrated the practical application of the STRIDeR workflow in pelvic SABR re-irradiation cases.

Conclusions:

  • The STRIDeR pathway successfully guides radiobiologically meaningful and anatomically appropriate re-irradiation treatment planning within a commercial TPS.
  • This standardized and transparent approach facilitates more informed re-irradiation decisions.
  • STRIDeR improves the cumulative evaluation of organ at risk doses, enhancing patient safety and treatment efficacy.