NDLI: A margin-of-the-day online adaptive intensity-modulated radiotherapy strategy for cervical cancer provides superior treatment accuracy compared to clinically recommended margins: a dosimetric evaluation.

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A margin-of-the-day online adaptive intensity-modulated radiotherapy strategy for cervical cancer provides superior treatment accuracy compared to clinically recommended margins: a dosimetric evaluation.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Ahmad, Rozilawati Bondar, Luiza Voet, Peter Mens, Jan-Willem Quint, Sandra Dhawtal, Glenn Heijmen, Ben Hoogeman, Mischa
Description	Country affiliation: Netherlands Author Affiliation: Ahmad R ( Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center , Rotterdam , The Netherlands.)
Abstract	PURPOSE: To dosimetrically evaluate a margin-of-the-day (MoD) online adaptive intensity-modulated radiotherapy (IMRT) strategy for cervical cancer patients. The strategy is based on a single planning computed tomography (CT) scan and a pretreatment constructed IMRT plan library with incremental clinical target volumes (CTV)-to-planning target volumes (PTV) margins. MATERIAL AND METHODS: For 14 patients, 9-10 variable bladder filling CT scans acquired at pretreatment and after 40 Gy were available. Bladder volume variability during the treatment course was recorded by twice-weekly US bladder-volume measurements. A MoD strategy that selects the best IMRT plan of the day from a library of plans with incremental margins in steps of 5 mm was compared with a clinically recommended population-based margin (15 mm). To compare the strategies, for each fraction that had a recorded US bladder-volume measurement, the CT scan with the nearest bladder volume was selected from the pretreatment CT series and from the CT series acquired after 40 Gy. A frequency-weighted average of the dose-volume histograms (DVH) parameters calculated for the two selected CT scans was used to estimate the DVH parameters of the fraction of interest. RESULTS: The 15-mm recommended margin resulted in cervix-uterus underdosage in six of 14 patients. Compared with the 15-mm margin, the MoD strategy resulted in significantly better cervix-uterus coverage (p = 0.008) without a significant difference in the sparing of rectum, bladder, and small bowel. For each patient, 3-8 (median 5) plans were needed in the library of plans for the MoD strategy. The required range of the MoD was 5-45 mm (median 15 mm). Twenty-five percent of all fractions could be treated with a MoD of 5 mm and 81% of all fractions could be treated with a MoD up to 25 mm. CONCLUSIONS: Compared with a clinically recommended margin, a simple online adaptive strategy resulted in better cervix-uterus coverage without compromising organs at risk sparing.
File Format	HTM / HTML
ISSN	0284186X
e-ISSN	1651226X
Journal	Acta Oncologica
Issue Number	7
Volume Number	52
Language	English
Publisher	Taylor and Francis
Publisher Date	2013-10-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Oncology Radiometry Radiotherapy Planning, Computer-assisted Radiotherapy, Image-guided Tomography, X-ray Computed Uterine Cervical Neoplasms Radiotherapy Neoplasm Staging Online Systems Organs At Risk Radiation Effects Prognosis Radiotherapy, Intensity-modulated Urinary Bladder Comparative Study Evaluation Studies Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Hematology Oncology

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