Dosimetric Comparison of MR-linac-based IMRT and Conventional VMAT Treatment Plans for Prostate Cancer

Overview

Journal Radiat Oncol

Publisher Biomed Central

Specialties Oncology
Radiology

Date 2021 Jul 22

PMID 34289868

Citations 19

Authors

Vanessa da Silva Mendes

Lukas Nierer

Minglun Li

Stefanie Corradini

Michael Reiner

Florian Kamp

Maximilian Niyazi

Christopher Kurz

Guillaume Landry

Claus Belka

Affiliations

Soon will be listed here.

Abstract

Background: The aim of this study was to evaluate and compare the performance of intensity modulated radiation therapy (IMRT) plans, planned for low-field strength magnetic resonance (MR) guided linear accelerator (linac) delivery (labelled IMRT MRL plans), and clinical conventional volumetric modulated arc therapy (VMAT) plans, for the treatment of prostate cancer (PCa). Both plans used the original planning target volume (PTV) margins. Additionally, the potential dosimetric benefits of MR-guidance were estimated, by creating IMRT MRL plans using smaller PTV margins.

Materials And Methods: 20 PCa patients previously treated with conventional VMAT were considered. For each patient, two different IMRT MRL plans using the low-field MR-linac treatment planning system were created: one with original (orig.) PTV margins and the other with reduced (red.) PTV margins. Dose indices related to target coverage, as well as dose-volume histogram (DVH) parameters for the target and organs at risk (OAR) were compared. Additionally, the estimated treatment delivery times and the number of monitor units (MU) of each plan were evaluated.

Results: The dose distribution in the high dose region and the target volume DVH parameters (D, D, D and V) were similar for all three types of treatment plans, with deviations below 1% in most cases. Both IMRT MRL plans (orig. and red. PTV margins) showed similar homogeneity indices (HI), however worse values for the conformity index (CI) were also found when compared to VMAT. The IMRT MRL plans showed similar OAR sparing when the orig. PTV margins were used but a significantly better sparing was feasible when red. PTV margins were applied. Higher number of MU and longer predicted treatment delivery times were seen for both IMRT MRL plans.

Conclusions: A comparable plan quality between VMAT and IMRT MRL plans was achieved, when applying the same PTV margin. However, online MR-guided adaptive radiotherapy allows for a reduction of PTV margins. With a red. PTV margin, better sparing of the surrounding tissues can be achieved, while maintaining adequate target coverage. Nonetheless, longer treatment delivery times, characteristic for the IMRT technique, have to be expected.

Citing Articles

Assessing population-based to personalized planning strategies for head and neck adaptive radiotherapy.

Visak J, Liao C, Zhong X, Wang B, Domal S, Wang H J Appl Clin Med Phys. 2024; 26(3):e14576.

PMID: 39626092 PMC: 11905247. DOI: 10.1002/acm2.14576.

Evaluation of the geometric and dosimetric accuracies of deformable image registration of targets and critical organs in prostate CBCT-guided adaptive radiotherapy.

Jassim H, Nedaie H, Banaee N, Geraily G, Kazemian A, Makrani D J Appl Clin Med Phys. 2024; 25(11):e14490.

PMID: 39270157 PMC: 11540054. DOI: 10.1002/acm2.14490.

Stereotactic ultrahypofractionated MR-guided radiotherapy for localized prostate cancer - Acute toxicity and patient-reported outcomes in the prospective, multicenter phase II trial.

Fink C, Ristau J, Buchele C, Kluter S, Liermann J, Hoegen-Sassmannshausen P Clin Transl Radiat Oncol. 2024; 46:100771.

PMID: 38586081 PMC: 10998039. DOI: 10.1016/j.ctro.2024.100771.

Comparative Study of Eclipse and RayStation Multi-Criteria Optimization-Based Prostate Radiotherapy Treatment Planning Quality.

Wong J, Leung V, Hung R, Ng C Diagnostics (Basel). 2024; 14(5).

PMID: 38472938 PMC: 10931516. DOI: 10.3390/diagnostics14050465.

Impact of daily plan adaptation on accumulated doses in ultra-hypofractionated magnetic resonance-guided radiation therapy of prostate cancer.

Xiong Y, Rabe M, Rippke C, Kawula M, Nierer L, Kluter S Phys Imaging Radiat Oncol. 2024; 29:100562.

PMID: 38463219 PMC: 10924058. DOI: 10.1016/j.phro.2024.100562.

References

Kim J, Park J, Choi C, An H, Kim Y, Kim J . Retrospective study comparing MR-guided radiation therapy (MRgRT) setup strategies for prostate treatment: repositioning vs. replanning. Radiat Oncol. 2019; 14(1):139. PMC: 6683369. DOI: 10.1186/s13014-019-1349-2. View

Choi C, Kim J, Kim J, Park J . Comparison of treatment plan quality among MRI-based IMRT with a linac, MRI-based IMRT with tri-Co-60 sources, and VMAT for spine SABR. PLoS One. 2019; 14(7):e0220039. PMC: 6645671. DOI: 10.1371/journal.pone.0220039. View

Li M, Li G, Hou X, Gao H, Xu Y, Zhao T . A Dosimetric Comparison between Conventional Fractionated and Hypofractionated Image-guided Radiation Therapies for Localized Prostate Cancer. Chin Med J (Engl). 2016; 129(12):1447-54. PMC: 4910368. DOI: 10.4103/0366-6999.183429. View

Fischer-Valuck B, Rao Y, Michalski J . Intensity-modulated radiotherapy for prostate cancer. Transl Androl Urol. 2018; 7(3):297-307. PMC: 6043750. DOI: 10.21037/tau.2017.12.16. View

Mannerberg A, Persson E, Jonsson J, Gustafsson C, Gunnlaugsson A, Olsson L . Dosimetric effects of adaptive prostate cancer radiotherapy in an MR-linac workflow. Radiat Oncol. 2020; 15(1):168. PMC: 7350593. DOI: 10.1186/s13014-020-01604-5. View

Khoo V, Joon D . New developments in MRI for target volume delineation in radiotherapy. Br J Radiol. 2006; 79 Spec No 1:S2-15. DOI: 10.1259/bjr/41321492. View

Hodapp N . [The ICRU Report 83: prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT)]. Strahlenther Onkol. 2012; 188(1):97-9. DOI: 10.1007/s00066-011-0015-x. View

Verbakel W, Cuijpers J, Hoffmans D, Bieker M, Slotman B, Senan S . Volumetric intensity-modulated arc therapy vs. conventional IMRT in head-and-neck cancer: a comparative planning and dosimetric study. Int J Radiat Oncol Biol Phys. 2009; 74(1):252-9. DOI: 10.1016/j.ijrobp.2008.12.033. View

Rosenberg S, Henke L, Shaverdian N, Mittauer K, Wojcieszynski A, Hullett C . A Multi-Institutional Experience of MR-Guided Liver Stereotactic Body Radiation Therapy. Adv Radiat Oncol. 2019; 4(1):142-149. PMC: 6349638. DOI: 10.1016/j.adro.2018.08.005. View

10.

Maund I, Benson R, Fairfoul J, Cook J, Huddart R, Poynter A . Image-guided radiotherapy of the prostate using daily CBCT: the feasibility and likely benefit of implementing a margin reduction. Br J Radiol. 2014; 87(1044):20140459. PMC: 4243197. DOI: 10.1259/bjr.20140459. View

11.

Corradini S, Alongi F, Andratschke N, Belka C, Boldrini L, Cellini F . MR-guidance in clinical reality: current treatment challenges and future perspectives. Radiat Oncol. 2019; 14(1):92. PMC: 6551911. DOI: 10.1186/s13014-019-1308-y. View

12.

Paddick I . A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg. 2001; 93 Suppl 3:219-22. DOI: 10.3171/jns.2000.93.supplement. View

13.

McPartlin A, Li X, Kershaw L, Heide U, Kerkmeijer L, Lawton C . MRI-guided prostate adaptive radiotherapy - A systematic review. Radiother Oncol. 2016; 119(3):371-80. DOI: 10.1016/j.radonc.2016.04.014. View

14.

Camps S, Fontanarosa D, de With P, Verhaegen F, Vanneste B . The Use of Ultrasound Imaging in the External Beam Radiotherapy Workflow of Prostate Cancer Patients. Biomed Res Int. 2018; 2018:7569590. PMC: 5829356. DOI: 10.1155/2018/7569590. View

15.

Hoffmann M, Pacey J, Goodworth J, Laszcyzk A, Ford R, Chick B . Analysis of a volumetric-modulated arc therapy (VMAT) single phase prostate template as a class solution. Rep Pract Oncol Radiother. 2018; 24(1):92-96. PMC: 6251366. DOI: 10.1016/j.rpor.2018.10.009. View

16.

Henke L, Olsen J, Contreras J, Curcuru A, DeWees T, Green O . Stereotactic MR-Guided Online Adaptive Radiation Therapy (SMART) for Ultracentral Thorax Malignancies: Results of a Phase 1 Trial. Adv Radiat Oncol. 2019; 4(1):201-209. PMC: 6349650. DOI: 10.1016/j.adro.2018.10.003. View

17.

Stanley J, Breitman K, Dunscombe P, Spencer D, Lau H . Evaluation of stereotactic radiosurgery conformity indices for 170 target volumes in patients with brain metastases. J Appl Clin Med Phys. 2011; 12(2):3449. PMC: 5718686. DOI: 10.1120/jacmp.v12i2.3449. View

18.

Oates R, Gill S, Foroudi F, Lim Joon M, Schneider M, Bressel M . What benefit could be derived from on-line adaptive prostate radiotherapy using rectal diameter as a predictor of motion?. J Med Phys. 2015; 40(1):18-23. PMC: 4471640. DOI: 10.4103/0971-6203.152237. View

19.

Nicosia L, Sicignano G, Rigo M, Figlia V, Cuccia F, Simone A . Daily dosimetric variation between image-guided volumetric modulated arc radiotherapy and MR-guided daily adaptive radiotherapy for prostate cancer stereotactic body radiotherapy. Acta Oncol. 2020; 60(2):215-221. DOI: 10.1080/0284186X.2020.1821090. View

20.

Park J, Park S, Kim H, Wu H, Carlson J, Kim J . A comparative planning study for lung SABR between tri-Co-60 magnetic resonance image guided radiation therapy system and volumetric modulated arc therapy. Radiother Oncol. 2016; 120(2):279-85. DOI: 10.1016/j.radonc.2016.06.013. View