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Online Adaptive Five-Fraction Ablative Radiotherapy for Prostate Cancer Using a Conventional Linear Accelerator.

Juan-Francisco Calvo-Ortega1, Coral Laosa-Bello2, Sandra Moragues-Femenía2

  • 1Hospital Quirónsalud Barcelona, Servicio de Oncología Radioterápica, Barcelona. Spain; Hospital Quirónsalud Málaga, Servicio de Oncología Radioterápica, Málaga. Spain.

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Summary

Online adaptive stereotactic body radiation therapy (SBRT) for prostate cancer ensures optimal target coverage. This method is clinically feasible, offering improved prostate coverage compared to conventional image-guided radiation therapy (IGRT).

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Area of Science:

  • Radiation Oncology
  • Medical Physics

Background:

  • Prostate cancer management requires precise radiation delivery to maximize tumor control and minimize toxicity.
  • Conventional image-guided radiation therapy (IGRT) may face challenges in maintaining optimal target coverage due to anatomical variations.
  • Online adaptive radiotherapy offers a potential solution for real-time treatment adjustments.

Purpose of the Study:

  • To evaluate the dosimetric outcomes of an online adaptive stereotactic body radiation therapy (SBRT) program for prostate cancer.
  • To compare the efficacy of online adaptive SBRT with conventional IGRT for prostate cancer treatment.

Main Methods:

  • Online adaptive prostate SBRT using a 5-fraction regimen was implemented with a conventional linear accelerator.
  • A daily adaptive "plan-of-the-day" (POD) was generated using CBCT imaging for each fraction.
  • Dosimetric analysis included target coverage, organs-at-risk (OARs) sparing, patient-specific quality assurance (PSQA), and treatment timing.

Main Results:

  • Online adaptive SBRT achieved optimal prostate coverage in all fractions.
  • Conventional IGRT plans failed to provide adequate prostate coverage (V40 Gy ≥ 95%) in 70% of fractions.
  • Patient-specific quality assurance demonstrated excellent agreement, and adaptation time averaged 20.1 minutes.

Conclusions:

  • The online adaptive SBRT program for prostate cancer is clinically feasible using a conventional linear accelerator.
  • This adaptive approach ensures superior target coverage compared to conventional IGRT.
  • The program adheres to established clinical trial acceptance criteria.