Cone Beam Computed Tomography-Based Online Adaptive Radiation Therapy of Esophageal Cancer: First Clinical Experience and Dosimetric Benefits

Nicolas Bachmann, MD; Daniel Schmidhalter, BE; Frédéric Corminboeuf, MD; Martin D. Berger, MD; Yves Borbély, MD; Ekin Ermiş, MD; Emanuel Stutz, MD; Binaya K. Shrestha, MD; Daniel M. Aebersold, MD; Peter Manser, MD; Hossein Hemmatazad, MD

Advances in Radiation Oncology (Jan 2025)

Cone Beam Computed Tomography-Based Online Adaptive Radiation Therapy of Esophageal Cancer: First Clinical Experience and Dosimetric Benefits

Nicolas Bachmann, MD,
Daniel Schmidhalter, BE,
Frédéric Corminboeuf, MD,
Martin D. Berger, MD,
Yves Borbély, MD,
Ekin Ermiş, MD,
Emanuel Stutz, MD,
Binaya K. Shrestha, MD,
Daniel M. Aebersold, MD,
Peter Manser, MD,
Hossein Hemmatazad, MD

Affiliations

Nicolas Bachmann, MD: Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern Switzerland, Bern, Switzerland; Corresponding author: Nicolas Bachmann
Daniel Schmidhalter, BE: Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern Switzerland, Bern, Switzerland
Frédéric Corminboeuf, MD: Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern Switzerland, Bern, Switzerland
Martin D. Berger, MD: Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern Switzerland, Bern, Switzerland
Yves Borbély, MD: Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern Switzerland, Bern, Switzerland
Ekin Ermiş, MD: Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern Switzerland, Bern, Switzerland
Emanuel Stutz, MD: Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern Switzerland, Bern, Switzerland
Binaya K. Shrestha, MD: Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern Switzerland, Bern, Switzerland
Daniel M. Aebersold, MD: Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern Switzerland, Bern, Switzerland
Peter Manser, MD: Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern Switzerland, Bern, Switzerland
Hossein Hemmatazad, MD: Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern Switzerland, Bern, Switzerland

Journal volume & issue: Vol. 10, no. 1
p. 101656

Abstract

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Purpose: Radiation therapy (RT) plays a key role in the management of esophageal cancer (EC). However, toxicities caused by proximity of organs at risk (OAR) and daily target coverage caused by interfractional anatomic changes are of concern. Daily online adaptive RT (oART) addresses these concerns and has the potential to increase OAR sparing and improve target coverage. We present the first clinical experience and dosimetric investigations of cone beam CT-based oART in EC using the ETHOS platform. Methods and Materials: Treatment fractions of the first 10 EC patients undergoing cone beam CT-based oART at our institution were retrospectively analyzed. The prescription dose was 50.4 Gy in 28 fractions. The same clinical target volume (CTV) and planning target volume (PTV) margins as for nonadaptive treatments were used. For all sessions, the timestamp of each oART workflow step, PTV size, target volume doses, mean heart dose, and lung V20Gy of both the scheduled and the adapted treatment plan were analyzed. Results: Following automatic propagation, the CTV was adapted by the physician in 164 (59%) fractions. The adapted treatment plan was selected in 276 (99%) sessions. The median time needed for an oART session was 28 minutes (range, 14.8-43.3). Compared to the scheduled plans, a significant relative reduction of 9.5% in mean heart dose (absolute, 1.6 Gy; P = .006) and 16.9% reduction in mean lung V20Gy (absolute, 2.3%; P < .001) was achieved with the adapted treatment plans. Simultaneously, we observed a significant relative improvement in D99%PTV and D99%CTV by 15.3% (P < .001) and 5.0% (P = .008), respectively, along with a significant increase in D95%PTV by 5.1% (P = .003). Conclusions: Although being resource-intensive, oART for EC is feasible in a reasonable timeframe and results in increased OAR sparing and improved target coverage, even without a reduction of margins. Further studies are planned to evaluate the potential clinical benefits.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

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