Adaptive prostate IGRT combining online re-optimization and re-positioning: a feasibility study

Phys Med Biol. 2011 Mar 7;56(5):1243-58. doi: 10.1088/0031-9155/56/5/002. Epub 2011 Feb 1.

Abstract

In prostate radiation therapy, inter-fractional organ motion/deformation has posed significant challenges on reliable daily dose delivery. To correct for this issue, off-line re-optimization and online re-positioning have been used clinically. In this paper, we propose an adaptive images guided radiation therapy (AIGRT) scheme that combines these two correction methods in an anatomy-driven fashion. The AIGRT process first tries to find a best plan for the daily target from a plan pool, which consists of the original CT plan and all previous re-optimized plans. If successful, the selected plan is used for daily treatment with translational shifts. Otherwise, the AIGRT invokes the re-optimization process of the CT plan for the anatomy of the day, which is afterward added to the plan pool as a candidate for future fractions. The AIGRT scheme is evaluated by comparisons with daily re-optimization and online re-positioning techniques based on daily target coverage, organs at risk (OAR) sparing and implementation efficiency. Simulated treatment courses for 18 patients with re-optimization alone, re-positioning alone and AIGRT shows that AIGRT offers reliable daily target coverage that is highly comparable to daily re-optimization and significantly improves from re-positioning. AIGRT is also seen to provide improved OAR sparing compared to re-positioning. Apart from dosimetric benefits, AIGRT in addition offers an efficient scheme to integrate re-optimization to current re-positioning-based IGRT workflow.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Feasibility Studies
  • Humans
  • Male
  • Organs at Risk / radiation effects
  • Patient Positioning / methods*
  • Prostatic Neoplasms / diagnostic imaging
  • Prostatic Neoplasms / radiotherapy*
  • Radiotherapy Planning, Computer-Assisted / methods*
  • Radiotherapy, Conformal / adverse effects
  • Radiotherapy, Conformal / methods*
  • Tomography, X-Ray Computed