CT-guided versus MR-guided radiotherapy: Impact on gastrointestinal sparing in adrenal stereotactic body radiotherapy. (January 2022)

• Record Type: Journal Article
• Authors: Rodriguez, Lori L.; Kotecha, Rupesh; Tom, Martin C.; Chuong, Michael D.; Contreras, Jessika A.; Romaguera, Tino; Alvarez, Diane; McCulloch, James; Herrera, Robert; Hernandez, Rene J.; Mercado, Jairo; Mehta, Minesh P.; Gutierrez, Alonso N.; Mittauer, Kathryn E.
• Is Part Of: Radiotherapy and oncology. Volume 166(2022)
• Page Start: 101
• Page End: 109
• Publication Date: 2022-01
• Subjects: MR-guided radiotherapy -- Adrenal cancer -- SBRT -- Adaptive radiotherapy -- Motion management; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2021.11.024
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: VMAT CT-IGRTBH provides superior target coverage and conformality over IMRT MRgRTBH . VMAT CT-IGRTFB provides inferior target coverage and OAR sparing vs IMRT MRgRTBH . Non-adaptive CT-IGRTBH had a 72% frequency of predicted indications for adaptation. Adaptive MRgRTBH safely provides ablative doses to adrenal mets near mobile GI OARs. Abstract: Background and purpose: To quantify the indication for adaptive, gated breath-hold (BH) MR-guided radiotherapy (MRgRTBH ) versus BH or free-breathing (FB) CT-based image-guided radiotherapy (CT-IGRT) for the ablative treatment of adrenal malignancies. Materials and methods: Twenty adrenal patients underwent adaptive IMRT MRgRTBH to a median dose of 50 Gy/5 fractions. Each patient was replanned for VMAT CT-IGRTBH and CT-IGRTFB on a c-arm linac. Only CT-IGRTFB used an ITV, summed from GTVs of all phases of the 4DCT respiratory evaluation. All used the same 5 mm GTV/ITV to PTV expansion. Metrics evaluated included: target volume and coverage, conformality, mean ipsilateral kidney and 0.5 cc gastrointestinal organ-at-risk (OAR) doses (D0.5cc ). Adaptive dose for MRgRTBH and predicted dose (i.e., initial plan re-calculated on anatomy of the day) was performed for CT-IGRTBH and MRgRTBH to assess frequency of OAR violations and coverage reductions for each fraction. Results: The more common VMAT CT-IGRTFB, with its significantly larger target volumes, proved inferior to MRgRTBH in mean PTV and ITV/GTV coverage, as well as small bowel D0.5cc . Conversely, VMAT CT-IGRTBH delivered a dosimetrically superior initial plan in terms of statistically significant ( p ≤ 0.02) improvements in target coverage, conformality and D0.5cc to the large bowel, duodenum and mean ipsilateral kidney compared to IMRT MRgRTBH . However, non-adaptive CT-IGRTBH had a 71.8% frequency of predicted indications for adaptation and was 2.8 times more likely to experience a coverage reduction in PTV D95% than predicted for MRgRTBH . Conclusion: Breath-hold VMAT radiotherapy provides superior target coverage and conformality over MRgRTBH, but the ability of MRgRTBH to safely provide ablative doses to adrenal lesions near mobile luminal OAR through adaptation and direct, real-time motion tracking is unmatched.