Full daily re-optimization improves plan quality during online adaptive radiotherapy

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Benjamin Tengler - , University of Tübingen (Author)
  • Luise A. Künzel - , National Center for Tumor Diseases (NCT) Dresden, University Hospital Carl Gustav Carus Dresden (Author)
  • Markus Hagmüller - , University of Tübingen (Author)
  • David Mönnich - , University of Tübingen (Author)
  • Simon Boeke - , University of Tübingen (Author)
  • Daniel Wegener - , University of Tübingen (Author)
  • Cihan Gani - , University of Tübingen (Author)
  • Daniel Zips - , University of Tübingen (Author)
  • Daniela Thorwarth - , University of Tübingen (Author)

Abstract

Background and purpose: Daily online treatment plan adaptation requires a fast workflow and planning process. Current online planning consists of adaptation of a predefined reference plan, which might be suboptimal in cases of large anatomic changes. The aim of this study was to investigate plan quality differences between the current online re-planning approach and a complete re-optimization. Material and methods: Magnetic resonance linear accelerator reference plans for ten prostate cancer patients were automatically generated using particle swarm optimization (PSO). Adapted plans were created for each fraction using (1) the current re-planning approach and (2) full PSO re-optimization and evaluated overall compliance with institutional dose-volume criteria compared to (3) clinically delivered fractions. Relative volume differences between reference and daily anatomy were assessed for planning target volumes (PTV60, PTV57.6), rectum and bladder and correlated with dose-volume results. Results: The PSO approach showed significantly higher adherence to dose-volume criteria than the reference approach and clinical fractions (p < 0.001). In 74 % of PSO plans at most one criterion failed compared to 56 % in the reference approach and 41 % in clinical plans. A fair correlation between PTV60 D98% and relative bladder volume change was observed for the reference approach. Bladder volume reductions larger than 50 % compared to the reference plan recurrently decreased PTV60 D98% below 56 Gy. Conclusion: Complete re-optimization maintained target coverage and organs at risk sparing even after large anatomic variations. Re-planning based on daily magnetic resonance imaging was sufficient for small variations, while large variations led to decreasing target coverage and organ-at-risk sparing.

Details

Original languageEnglish
Article number100534
JournalPhysics and imaging in radiation oncology
Volume29
Publication statusPublished - Jan 2024
Peer-reviewedYes

Keywords

Sustainable Development Goals

Keywords

  • Adaptive treatment planning, MR-Linac, MRI guided radiotherapy, Online plan optimization