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3-Dimensional target coverage assessment for MRI guided esophageal cancer radiotherapy.

MRI 引导食管癌放疗的三维靶覆盖评估。

  • 影响因子:4.55
  • DOI:10.1016/j.radonc.2020.03.007
  • 作者列表:"Boekhoff MR","Defize IL","Borggreve AS","Takahashi N","van Lier ALHMW","Ruurda JP","van Hillegersberg R","Lagendijk JJW","Mook S","Meijer GJ
  • 发表时间:2020-03-28
Abstract

PURPOSE:This study aimed to quantify the coverage probability for esophageal cancer radiotherapy as a function of a preset margin for online MR-guided and (CB)CT-guided radiotherapy. METHODS:Thirty esophageal cancer patients underwent six T2-weighted MRI scans, 1 prior to treatment and 5 during neoadjuvant chemoradiotherapy at weekly intervals. Gross tumor volume (GTV) and clinical target volume (CTV) were delineated on each individual scan. Follow-up scans were rigidly aligned to the bony anatomy and to the clinical target volume itself, mimicking two online set-up correction strategies: a conventional CBCT-guided set-up and a MR-guided set-up, respectively. Geometric coverage probability of the propagated CTVs was assessed for both set-up strategies by expanding the reference CTV with an isotropic margin varying from 0 mm to 15 mm with an increment of 1 mm. RESULTS:A margin of 10 mm could resolve the interfractional changes for 118 out of the 132 (89%) analyzed fractions when applying a bone-match registration, whereas the CTV was adequately covered in 123 (93%) fractions when the registration was directly performed at the CTV itself (soft-tissue registration). Closer analyses revealed that target coverage violation predominantly occurred for distal tumors near the junction and into the cardia. CONCLUSION:Online MR-guided soft-tissue registration protocols exhibited modest improvements of the geometric target coverage probability as compared to online CBCT-guided bone match protocols. Therefore, highly conformal target irradiation using online MR-guidance can only be achieved by implementing on-table adaptive workflows where new treatment plans are daily generated based on the anatomy of the day.

摘要

目的: 本研究旨在量化食管癌放疗的覆盖概率,作为在线 MR 引导和 (CB)CT 引导放疗预设边缘的函数。 方法: 30 例食管癌患者接受了 6 T2-weighted MRI 扫描,1 例在治疗前和 5 例在新辅助放化疗期间每周间隔。在每个个体扫描上勾画大体肿瘤体积 (GTV) 和临床靶体积 (CTV)。随访扫描与骨解剖学和临床目标体积本身严格对齐,模拟两种在线设置矫正策略: 常规 CBCT 引导设置和 MR 引导设置。通过扩展各向同性裕度从 0毫米变化到 15毫米,增量为 1毫米的参考 CTV,评估了两种设置策略的传播 CTV 的几何覆盖概率。 结果: 当应用骨匹配配准时,10毫米的余量可以解决 118 (132) 分析分数中的 89% 的分数间变化,而当直接在 CTV 本身进行注册 (软组织注册) 时,CTV 被 123 (93%) 个分数充分覆盖。更密切的分析显示,侵犯目标覆盖主要发生在连接处附近和进入贲门的远端肿瘤。 结论: 与在线 CBCT 引导的骨匹配方案相比,在线 MR 引导的软组织配准方案显示了几何目标覆盖概率的适度改善。因此,使用在线 MR 引导的高适形靶照射只能通过实施基于当天解剖结构的日常生成新治疗计划的台式自适应工作流来实现。

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影响因子:1.24
发表时间:2020-01-01
DOI:10.3892/etm.2019.8190
作者列表:["Shang L","Pei QS","Xu D","Liu JY","Liu J"]

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影响因子:2.64
发表时间:2020-01-01
DOI:10.1007/s11605-019-04456-x
作者列表:["Campos VJ","Mazzini GS","Juchem JF","Gurski RR"]

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