Cone Beam CT-Based Daily Adaptive Planning or Defined-Filling Protocol for Neoadjuvant Gastric Cancer Radiation Therapy: A Comparison

Gustavo R. Sarria, MD; Hanna Schmitt, cand Med/MSc; Lennart Jahnke, PhD; Daniel Bürgy, MD; Frederik Wenz, MD; Kerstin Siebenlist, MSc; Frank A. Giordano, MD; Anika Jahnke, PhD; Judit Boda-Heggemann, MD, PhD

Advances in Radiation Oncology (Jan 2021)

Cone Beam CT-Based Daily Adaptive Planning or Defined-Filling Protocol for Neoadjuvant Gastric Cancer Radiation Therapy: A Comparison

Gustavo R. Sarria, MD,
Hanna Schmitt, cand Med/MSc,
Lennart Jahnke, PhD,
Daniel Bürgy, MD,
Frederik Wenz, MD,
Kerstin Siebenlist, MSc,
Frank A. Giordano, MD,
Anika Jahnke, PhD,
Judit Boda-Heggemann, MD, PhD

Affiliations

Gustavo R. Sarria, MD: Department of Radiation Oncology, University Hostpital Bonn, University of Bonn, Bonn, Germany
Hanna Schmitt, cand Med/MSc: Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Lennart Jahnke, PhD: Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; University Heart Center Freiburg, University Medical Center Freiburg, Medical Faculty Freiburg, Freiburg University, Freiburg, Germany
Daniel Bürgy, MD: Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Frederik Wenz, MD: Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; University Medical Center Freiburg, Medical Faculty Freiburg, Freiburg University, Freiburg, Germany
Kerstin Siebenlist, MSc: Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Frank A. Giordano, MD: Department of Radiation Oncology, University Hostpital Bonn, University of Bonn, Bonn, Germany
Anika Jahnke, PhD: Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute for Digitalization in Medicine, University Medical Center Freiburg, Medical Faculty Freiburg, Freiburg University, Freiburg, Germany
Judit Boda-Heggemann, MD, PhD: Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Corresponding author: Judit Boda-Heggemann MD, PhD

Journal volume & issue: Vol. 6, no. 1
p. 100593

Abstract

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Purpose: This study aimed to investigate, in the setting of neoadjuvant gastric irradiation with integrated boost, whether cone beam computed tomography (CBCT)-based adaptive radiation therapy compared with a defined-filling protocol would be beneficial in terms of feasibility and achieving daily reproducible dose volume indexes of the planning target volume (PTV) and organs at risk (OARs) and workflow. Methods and materials: Planning computed tomography (PCT) and 25 CBCT scans of a previously treated patient were used, and neoadjuvant therapy of gastric carcinoma was simulated offline. PTVs and OARs were defined per the TOPGEAR protocol (PTV: 45 Gy/1.8 Gy), and an integrated boost (gross tumor volume [GTV]: 50.4 Gy/2.016 Gy) was added. The patient followed a filling regimen consisting of 12-hour fasting followed by 200 mL of water intake (2 glasses of water) immediately before irradiation. OARs and PTVs were newly contoured on each CBCT. Nonrigid registration of PCT and CBCT scans was performed. Nonadapted plans were recalculated on each CBCT (R-CBCT). Furthermore, an adapted plan was created for the new anatomy (A-CBCT). Dose parameters and comparison of R-CBCT and A-CBCT for the kidneys, liver, and heart were analyzed using a paired t test. Results: A total of 200 plans for R-CBCT and A-CBCT were obtained. Mean gastric volumes were 277.32 cm3 (±54.40 cm3) in CBCT scans and 519.2 cm3 in PCT. Mean doses to the PTV did not differ meaningfully within the CBCT scans, with an average of 1.54%. The D95 improved in GTV coverage by 5.26% compared with the R-CBCT plan. Mean heart, liver, and right kidney doses were reduced with the A-CBCT plan by 35.74%, 10.71% and 29.47%, respectively. The R- and A-CBCT comparison for GTV and OARs was significantly different in all cases (P < .0001). Conclusions: Adaptive radiation therapy through deformable registration represents an important tool in neoadjuvant gastric irradiation, encompassing daily variability and organ motion, compared with the defined-filling protocol while improving OAR sparing.

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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