Adaptive treatment margins to reduce organs at risk dose in patients with no or minimal anatomical changes in radiotherapy of non-small cell lung cancer
Background and purpose: In non-small cell lung cancer (NSCLC) a significant portion of the planning target volume (PTV) margin accommodates for anatomical changes during treatment. Patients with no or minimal anatomical changes might therefore benefit from a reduced PTV margin, resulting in lower or...
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Elsevier
2025-01-01
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| Series: | Physics and Imaging in Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405631625000041 |
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| author | Djoya Hattu Daisy Emans Janine Bouten Richard Canters Judith van Loon Dirk De Ruysscher |
| author_facet | Djoya Hattu Daisy Emans Janine Bouten Richard Canters Judith van Loon Dirk De Ruysscher |
| author_sort | Djoya Hattu |
| collection | DOAJ |
| description | Background and purpose: In non-small cell lung cancer (NSCLC) a significant portion of the planning target volume (PTV) margin accommodates for anatomical changes during treatment. Patients with no or minimal anatomical changes might therefore benefit from a reduced PTV margin, resulting in lower organ at risk (OAR) doses. We evaluated a plan of the day approach using different PTV margins to quantify its effect on OAR and clinical target volume (CTV) dose. Materials and methods: Twenty NSCLC patients were included in this retrospective study. CBCTs of all fractions were evaluated using an image-guided radiotherapy (IGRT) protocol to classify fractions into two groups: no or minimal anatomical changes to which reduced PTV margin plans (5 or 2 mm) were assigned, or with anatomical changes that received the reference treatment plan (8 mm PTV margin). OAR doses were investigated and CTV coverage was evaluated using CBCT dose recalculations. Results: All plans showed decreased OAR dose when the PTV margin was reduced from 8 mm to 5 mm or 2 mm. The IGRT protocol selected 254/600 fractions in 19/20 patients, that could be treated with a smaller margin. CTV V95% remained ≥95% in 94% of the 5 mm plans and 87% of the 2 mm plans, compared to 98% of the reference 8 mm plans. Conclusion: The IGRT protocol could identify fractions with no or minimal anatomical changes allowing a plan of the day approach to reduce PTV margins. Target coverage remained adequate in the majority of patients, while reducing OAR doses. |
| format | Article |
| id | doaj-art-92a5340b1fde4ba1b3503dffdb0454f3 |
| institution | Kabale University |
| issn | 2405-6316 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Physics and Imaging in Radiation Oncology |
| spelling | doaj-art-92a5340b1fde4ba1b3503dffdb0454f32025-01-29T05:01:29ZengElsevierPhysics and Imaging in Radiation Oncology2405-63162025-01-0133100699Adaptive treatment margins to reduce organs at risk dose in patients with no or minimal anatomical changes in radiotherapy of non-small cell lung cancerDjoya Hattu0Daisy Emans1Janine Bouten2Richard Canters3Judith van Loon4Dirk De Ruysscher5Corresponding author.; Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the NetherlandsDepartment of Radiation Oncology (MAASTRO), GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the NetherlandsDepartment of Radiation Oncology (MAASTRO), GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the NetherlandsDepartment of Radiation Oncology (MAASTRO), GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the NetherlandsDepartment of Radiation Oncology (MAASTRO), GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the NetherlandsDepartment of Radiation Oncology (MAASTRO), GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the NetherlandsBackground and purpose: In non-small cell lung cancer (NSCLC) a significant portion of the planning target volume (PTV) margin accommodates for anatomical changes during treatment. Patients with no or minimal anatomical changes might therefore benefit from a reduced PTV margin, resulting in lower organ at risk (OAR) doses. We evaluated a plan of the day approach using different PTV margins to quantify its effect on OAR and clinical target volume (CTV) dose. Materials and methods: Twenty NSCLC patients were included in this retrospective study. CBCTs of all fractions were evaluated using an image-guided radiotherapy (IGRT) protocol to classify fractions into two groups: no or minimal anatomical changes to which reduced PTV margin plans (5 or 2 mm) were assigned, or with anatomical changes that received the reference treatment plan (8 mm PTV margin). OAR doses were investigated and CTV coverage was evaluated using CBCT dose recalculations. Results: All plans showed decreased OAR dose when the PTV margin was reduced from 8 mm to 5 mm or 2 mm. The IGRT protocol selected 254/600 fractions in 19/20 patients, that could be treated with a smaller margin. CTV V95% remained ≥95% in 94% of the 5 mm plans and 87% of the 2 mm plans, compared to 98% of the reference 8 mm plans. Conclusion: The IGRT protocol could identify fractions with no or minimal anatomical changes allowing a plan of the day approach to reduce PTV margins. Target coverage remained adequate in the majority of patients, while reducing OAR doses.http://www.sciencedirect.com/science/article/pii/S2405631625000041Non-small cell lung cancerreduced PTV marginsAdaptive radiotherapyPlan of the dayLibrary of plansIGRT |
| spellingShingle | Djoya Hattu Daisy Emans Janine Bouten Richard Canters Judith van Loon Dirk De Ruysscher Adaptive treatment margins to reduce organs at risk dose in patients with no or minimal anatomical changes in radiotherapy of non-small cell lung cancer Physics and Imaging in Radiation Oncology Non-small cell lung cancer reduced PTV margins Adaptive radiotherapy Plan of the day Library of plans IGRT |
| title | Adaptive treatment margins to reduce organs at risk dose in patients with no or minimal anatomical changes in radiotherapy of non-small cell lung cancer |
| title_full | Adaptive treatment margins to reduce organs at risk dose in patients with no or minimal anatomical changes in radiotherapy of non-small cell lung cancer |
| title_fullStr | Adaptive treatment margins to reduce organs at risk dose in patients with no or minimal anatomical changes in radiotherapy of non-small cell lung cancer |
| title_full_unstemmed | Adaptive treatment margins to reduce organs at risk dose in patients with no or minimal anatomical changes in radiotherapy of non-small cell lung cancer |
| title_short | Adaptive treatment margins to reduce organs at risk dose in patients with no or minimal anatomical changes in radiotherapy of non-small cell lung cancer |
| title_sort | adaptive treatment margins to reduce organs at risk dose in patients with no or minimal anatomical changes in radiotherapy of non small cell lung cancer |
| topic | Non-small cell lung cancer reduced PTV margins Adaptive radiotherapy Plan of the day Library of plans IGRT |
| url | http://www.sciencedirect.com/science/article/pii/S2405631625000041 |
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