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CBCT-Based Online Adaptive, Ultra-Hypofractionated Radiotherapy for Prostate Cancer: First Clinical Experiences.

Georg Wurschi1,2,3, Alexander Voigt1,2, Noreen Murr1,2

  • 1Department of Radiation Oncology, Jena University Hospital, 07747 Jena, Germany.

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Summary
This summary is machine-generated.

Online-adaptive ultra-hypofractionated radiotherapy (uhRT) for prostate cancer is feasible, improving target coverage daily. However, treatment times are considerable, and a second CBCT scan is recommended for intra-fractional motion.

Keywords:
CBCTonline adaptive radiotherapyprostate cancerultra-hypofractionated radiotherapy

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Area of Science:

  • Radiation Oncology
  • Medical Physics

Background:

  • Ultra-hypofractionated radiotherapy (uhRT) requires high precision for localized prostate cancer.
  • Online-adaptive radiotherapy using Cone-Beam CT (CBCT) offers potential for improved accuracy but lacks clinical routine data.
  • This study investigates the initial clinical feasibility and technical aspects of online-adaptive uhRT.

Purpose of the Study:

  • To evaluate the feasibility and technical aspects of delivering online-adaptive uhRT in routine clinical practice for prostate cancer.
  • To assess the impact of online-adaptive uhRT on target volume coverage and organ at risk (OAR) doses.
  • To determine the required positional adjustments for intra-fractional motion compensation.

Main Methods:

  • Seven patients with low- or intermediate-risk prostate cancer received online-adaptive uhRT (5 fractions, 7.25 Gy or 8.00 Gy boost) on a Varian Ethos system.
  • Daily CBCT imaging was used for online plan adaptation.
  • Dose-volume histogram (DVH) parameters, treatment times, and positional adjustments were recorded retrospectively.

Main Results:

  • Online-adaptive uhRT was delivered daily or every other day, with a mean treatment time of 30:17 minutes.
  • Adaptive plans significantly improved target coverage (CTV1 V100%, PTV1/PTV2 D98%) compared to scheduled plans.
  • Adaptive plans were used in 91.4% of fractions, with positional adjustments up to 0.77 cm needed for intra-fractional motion.

Conclusions:

  • Online-adaptive uhRT is feasible in clinical routine for prostate cancer, enhancing target volume coverage.
  • Considerable treatment times are a factor, and a second CBCT scan is recommended to manage intra-fractional motion.
  • Further research on patient outcomes and cost-effectiveness is warranted.