How to protect the proximal bronchial tree during stereotactic radiotherapy of ultracentral lung tumors: Lessons from MR-guided treatment
Purpose: To use imaging data from stereotactic MR-guided online adaptive radiotherapy (SMART) of ultracentral lung tumors (ULT) for development of a safe non-adaptive approach towards stereotactic body radiotherapy (SBRT) of ULT. Patients and Methods: Analysis is based on 19 patients with ULT who re...
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Elsevier
2025-03-01
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| Series: | Clinical and Translational Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630824001769 |
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| author | Sebastian Regnery Efthimios Katsigiannopulos Hin Lau Philipp Hoegen-Saßmannshausen Fabian Weykamp Claudia Katharina Renkamp Carolin Rippke Fabian Schlüter Sophia Albert Jan Meis Marietta Kirchner Alexandra Balzer Nicolaus Andratschke Matthias Guckenberger Jürgen Debus Sebastian Klüter Juliane Hörner-Rieber |
| author_facet | Sebastian Regnery Efthimios Katsigiannopulos Hin Lau Philipp Hoegen-Saßmannshausen Fabian Weykamp Claudia Katharina Renkamp Carolin Rippke Fabian Schlüter Sophia Albert Jan Meis Marietta Kirchner Alexandra Balzer Nicolaus Andratschke Matthias Guckenberger Jürgen Debus Sebastian Klüter Juliane Hörner-Rieber |
| author_sort | Sebastian Regnery |
| collection | DOAJ |
| description | Purpose: To use imaging data from stereotactic MR-guided online adaptive radiotherapy (SMART) of ultracentral lung tumors (ULT) for development of a safe non-adaptive approach towards stereotactic body radiotherapy (SBRT) of ULT. Patients and Methods: Analysis is based on 19 patients with ULT who received SMART (10 × 5.0–5.5 Gy) on a 0.35 T MR-Linac (MRIdian®) in the prospective MAGELLAN trial. 4D-planning CT data of six patients served to quantify proximal bronchial tree (PBT) breathing motion. Daily fraction MRIs are used to calculate interfractional translations (mediolateral (ML), anterior-posterior (AP), superior-inferior (SI)) and their dosimetric consequences for the PBT. A planning risk volume (PRV) is calculated for an assumed non-adaptive SBRT in deep-inspiration breath hold (DIBH) with surface-guidance (AlignRT®). Finally, non-adaptive volumetric modulated arc (VMAT) SBRT is simulated with and without a PRV for N = 10 patients (10 × 5.5 Gy). Results: The PBT shows relevant breathing motion, especially in superior-inferior direction (median ML: 2.5 mm, AP: 1.9 mm and SI: 9.2 mm). Furthermore, moderate interfractional translations are observed (mean absolute translation ML: 1.3 mm, AP: 1.3 mm, SI: 1.1 mm), with an estimated 2 mm PRV margin for interfractional changes alone. Simulated non-adaptive SBRT leads to PBT overdoses in 60 % of patients (median overdosed fractions VMAT: 2.5, predicted MR-linac plans 4). Both MR-guided online plan adaptation (SMART) and PRV-based non-adaptive VMAT prevent PBT overdoses, but SMART yields significantly higher planning target volume (PTV) coverage (SMART: median 96 % [IQR 95–96], VMAT: median 89 % [IQR 77–94], p = 0.014). Conclusions: Both intrafractional breathing motion and interfractional translations may impact doses to the PBT during SBRT of ULT. SMART protects the PBT from overdoses while maintaining high PTV coverage. Non-adaptive SBRT appears safe with advanced breathing motion management and PRV, but yields inferior PTV coverage. |
| format | Article |
| id | doaj-art-87adb45fc6774fb8826d5e034eb9f047 |
| institution | Kabale University |
| issn | 2405-6308 |
| language | English |
| publishDate | 2025-03-01 |
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| series | Clinical and Translational Radiation Oncology |
| spelling | doaj-art-87adb45fc6774fb8826d5e034eb9f0472025-01-30T05:14:26ZengElsevierClinical and Translational Radiation Oncology2405-63082025-03-0151100899How to protect the proximal bronchial tree during stereotactic radiotherapy of ultracentral lung tumors: Lessons from MR-guided treatmentSebastian Regnery0Efthimios Katsigiannopulos1Hin Lau2Philipp Hoegen-Saßmannshausen3Fabian Weykamp4Claudia Katharina Renkamp5Carolin Rippke6Fabian Schlüter7Sophia Albert8Jan Meis9Marietta Kirchner10Alexandra Balzer11Nicolaus Andratschke12Matthias Guckenberger13Jürgen Debus14Sebastian Klüter15Juliane Hörner-Rieber16Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; NCT Partner Site Heidelberg, A Clinical-Translational Cancer Research Partnership between University Hospital Heidelberg and DKFZ, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, GermanyDepartment of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; NCT Partner Site Heidelberg, A Clinical-Translational Cancer Research Partnership between University Hospital Heidelberg and DKFZ, GermanyDepartment of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; NCT Partner Site Heidelberg, A Clinical-Translational Cancer Research Partnership between University Hospital Heidelberg and DKFZ, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, GermanyDepartment of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; NCT Partner Site Heidelberg, A Clinical-Translational Cancer Research Partnership between University Hospital Heidelberg and DKFZ, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, GermanyDepartment of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; NCT Partner Site Heidelberg, A Clinical-Translational Cancer Research Partnership between University Hospital Heidelberg and DKFZ, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, GermanyDepartment of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; NCT Partner Site Heidelberg, A Clinical-Translational Cancer Research Partnership between University Hospital Heidelberg and DKFZ, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, GermanyDepartment of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; NCT Partner Site Heidelberg, A Clinical-Translational Cancer Research Partnership between University Hospital Heidelberg and DKFZ, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, GermanyDepartment of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; NCT Partner Site Heidelberg, A Clinical-Translational Cancer Research Partnership between University Hospital Heidelberg and DKFZ, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, GermanyDepartment of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; NCT Partner Site Heidelberg, A Clinical-Translational Cancer Research Partnership between University Hospital Heidelberg and DKFZ, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, GermanyInstitute of Medical Biometry University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, GermanyInstitute of Medical Biometry University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, GermanyInstitute of Medical Biometry University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, GermanyDepartment of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, SwitzerlandDepartment of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, SwitzerlandDepartment of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; NCT Partner Site Heidelberg, A Clinical-Translational Cancer Research Partnership between University Hospital Heidelberg and DKFZ, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, GermanyDepartment of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; NCT Partner Site Heidelberg, A Clinical-Translational Cancer Research Partnership between University Hospital Heidelberg and DKFZ, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, GermanyDepartment of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; NCT Partner Site Heidelberg, A Clinical-Translational Cancer Research Partnership between University Hospital Heidelberg and DKFZ, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany; Corresponding author at: Department of Radiation Oncology, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany.Purpose: To use imaging data from stereotactic MR-guided online adaptive radiotherapy (SMART) of ultracentral lung tumors (ULT) for development of a safe non-adaptive approach towards stereotactic body radiotherapy (SBRT) of ULT. Patients and Methods: Analysis is based on 19 patients with ULT who received SMART (10 × 5.0–5.5 Gy) on a 0.35 T MR-Linac (MRIdian®) in the prospective MAGELLAN trial. 4D-planning CT data of six patients served to quantify proximal bronchial tree (PBT) breathing motion. Daily fraction MRIs are used to calculate interfractional translations (mediolateral (ML), anterior-posterior (AP), superior-inferior (SI)) and their dosimetric consequences for the PBT. A planning risk volume (PRV) is calculated for an assumed non-adaptive SBRT in deep-inspiration breath hold (DIBH) with surface-guidance (AlignRT®). Finally, non-adaptive volumetric modulated arc (VMAT) SBRT is simulated with and without a PRV for N = 10 patients (10 × 5.5 Gy). Results: The PBT shows relevant breathing motion, especially in superior-inferior direction (median ML: 2.5 mm, AP: 1.9 mm and SI: 9.2 mm). Furthermore, moderate interfractional translations are observed (mean absolute translation ML: 1.3 mm, AP: 1.3 mm, SI: 1.1 mm), with an estimated 2 mm PRV margin for interfractional changes alone. Simulated non-adaptive SBRT leads to PBT overdoses in 60 % of patients (median overdosed fractions VMAT: 2.5, predicted MR-linac plans 4). Both MR-guided online plan adaptation (SMART) and PRV-based non-adaptive VMAT prevent PBT overdoses, but SMART yields significantly higher planning target volume (PTV) coverage (SMART: median 96 % [IQR 95–96], VMAT: median 89 % [IQR 77–94], p = 0.014). Conclusions: Both intrafractional breathing motion and interfractional translations may impact doses to the PBT during SBRT of ULT. SMART protects the PBT from overdoses while maintaining high PTV coverage. Non-adaptive SBRT appears safe with advanced breathing motion management and PRV, but yields inferior PTV coverage.http://www.sciencedirect.com/science/article/pii/S2405630824001769Lung cancerUltracentralSBRTIGRTMR-guided radiotherapyRadiotherapy planning |
| spellingShingle | Sebastian Regnery Efthimios Katsigiannopulos Hin Lau Philipp Hoegen-Saßmannshausen Fabian Weykamp Claudia Katharina Renkamp Carolin Rippke Fabian Schlüter Sophia Albert Jan Meis Marietta Kirchner Alexandra Balzer Nicolaus Andratschke Matthias Guckenberger Jürgen Debus Sebastian Klüter Juliane Hörner-Rieber How to protect the proximal bronchial tree during stereotactic radiotherapy of ultracentral lung tumors: Lessons from MR-guided treatment Clinical and Translational Radiation Oncology Lung cancer Ultracentral SBRT IGRT MR-guided radiotherapy Radiotherapy planning |
| title | How to protect the proximal bronchial tree during stereotactic radiotherapy of ultracentral lung tumors: Lessons from MR-guided treatment |
| title_full | How to protect the proximal bronchial tree during stereotactic radiotherapy of ultracentral lung tumors: Lessons from MR-guided treatment |
| title_fullStr | How to protect the proximal bronchial tree during stereotactic radiotherapy of ultracentral lung tumors: Lessons from MR-guided treatment |
| title_full_unstemmed | How to protect the proximal bronchial tree during stereotactic radiotherapy of ultracentral lung tumors: Lessons from MR-guided treatment |
| title_short | How to protect the proximal bronchial tree during stereotactic radiotherapy of ultracentral lung tumors: Lessons from MR-guided treatment |
| title_sort | how to protect the proximal bronchial tree during stereotactic radiotherapy of ultracentral lung tumors lessons from mr guided treatment |
| topic | Lung cancer Ultracentral SBRT IGRT MR-guided radiotherapy Radiotherapy planning |
| url | http://www.sciencedirect.com/science/article/pii/S2405630824001769 |
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