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Pioneering Change in Radiotherapy With Biological Adaptive Radiotherapy for Lung Volumetric Modulated Radiotherapy

D Kawahara1, A S Koganezawa2, H Yamaguchi3

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A new Biological Adaptive Radiotherapy (BART) framework compensates for radiation dose reductions from treatment interruptions, preserving therapeutic efficacy in non-small cell lung cancer patients. This approach enhances precision and personalization in adaptive radiation therapy.

Keywords:
Accumulated biological doseAdaptiveCompensated biological equivalent dose (BED)CompensationInterruption

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Cancer Treatment

Background:

  • Adaptive radiotherapy aims to adjust treatment based on anatomical or biological changes during therapy.
  • Volumetric Modulated Arc Therapy (VMAT) is a common technique for delivering complex radiation doses.
  • Non-small cell lung cancer (NSCLC) treatment often involves precise dose delivery to maximize tumor control and minimize toxicity.

Purpose of the Study:

  • Introduce a Biological Adaptive Radiotherapy (BART) framework incorporating biological effects into adaptive planning.
  • Quantify the impact of intrafraction interruptions on biologically effective dose (BED) in Stage III NSCLC patients treated with VMAT.
  • Evaluate a compensation strategy to restore target BED while respecting organ-at-risk (OAR) constraints.

Main Methods:

  • Utilized a microdosimetric kinetic model (MKM) to calculate BED reductions from a 120-minute interruption in Stage III NSCLC patients treated with VMAT.
  • Generated compensation plans by converting biological dose deviations into physical dose adjustments using a treatment planning system (TPS).
  • Compared dose-volume histograms (DVHs) and other metrics between plans with and without interruptions, and after BART compensation.

Main Results:

  • A 120-minute interruption caused significant BED reductions in the planning target volume (D98% reduced by 15.7%-16.5%).
  • Normal lung dose (V5Gy, V20Gy) increased slightly due to the interruption (0.7%-4.7%).
  • BART compensation effectively reduced target BED deviations (D98% reduced to 0.8%-1.4%) and OAR dose increases (V5Gy reduced to 1.0%-4.1%), meeting spinal cord constraints.

Conclusions:

  • The BART framework successfully compensates for BED reductions caused by short-term treatment interruptions.
  • This approach preserves therapeutic efficacy and adheres to OAR constraints in NSCLC patients.
  • BART represents a significant advancement in adaptive radiation therapy, enhancing treatment precision and personalization.