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Improved Dosimetry with Daily Online Adaptive Radiotherapy for Cervical Cancer: Waltzing the Pear
1Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Clinical Oncology (Royal College of Radiologists (Great Britain))
|January 21, 2024
Summary
Daily online adaptive radiotherapy for cervical cancer allows for smaller margins, significantly improving organ at risk dosimetry and target coverage compared to standard image-guided radiotherapy.
Area of Science:
- Radiation Oncology
- Medical Physics
- Gynecologic Oncology
Background:
- Standard radiotherapy for locally advanced cervical cancer uses large margins to account for movement.
- Daily online cone-beam adaptive radiotherapy (CBART) enables real-time adjustments to treatment plans.
- Reducing margins in CBART may improve dose distribution to organs at risk (OARs) and the target volume.
Purpose of the Study:
- To evaluate the impact of reduced clinical target volume (CTV) to planning target volume (PTV) margins using daily online CBART.
- To compare OAR dosimetry and target coverage between daily online CBART and standard image-guided radiotherapy (IGRT).
Main Methods:
- Ten patients with locally advanced cervical cancer underwent chemoradiation with daily online CBART.
- CTV-to-PTV margins were reduced in CBART plans (0.5-1.0 cm) compared to standard IGRT plans (1.0-1.5 cm).
- Dosimetric parameters of adapted plans were compared to emulated IGRT plans.
Main Results:
- Daily online CBART significantly improved bowel bag dosimetry (V40 reduced by 91.3 cm³).
- Significant dose reductions were observed in the bladder and rectum.
- Improved uterocervix CTV coverage and reduced hotspots were noted with CBART compared to IGRT.
Conclusions:
- Reduced margins with daily online CBART enhance OAR dosimetry and target coverage for cervical cancer.
- Daily online CBART offers a superior alternative to standard IGRT for locally advanced cervical cancer.
- Further investigation into the clinical impact of improved dosimetry is warranted.
