Neurovascular bundle sparing in hypofractionated radiotherapy maintained with realistic treatment uncertainties
Background and purpose: Erectile dysfunction is a common side effect of radiotherapy for prostate cancer. To mitigate this toxicity, it has been suggested to limit the dose to critical nerves and vessels. We investigated the feasibility of sparing the neuro-vascular bundles (NVBs) in stereotactic bo...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-01-01
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| Series: | Physics and Imaging in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405631625000193 |
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| author | Roel C. Kwakernaak Victor J. Brand Jesús Rojo-Santiago Femke E. Froklage Mischa S. Hoogeman Steven J.M. Habraken Maaike T.W. Milder |
| author_facet | Roel C. Kwakernaak Victor J. Brand Jesús Rojo-Santiago Femke E. Froklage Mischa S. Hoogeman Steven J.M. Habraken Maaike T.W. Milder |
| author_sort | Roel C. Kwakernaak |
| collection | DOAJ |
| description | Background and purpose: Erectile dysfunction is a common side effect of radiotherapy for prostate cancer. To mitigate this toxicity, it has been suggested to limit the dose to critical nerves and vessels. We investigated the feasibility of sparing the neuro-vascular bundles (NVBs) in stereotactic body radiotherapy under the impact of realistic treatment uncertainties. Materials and methods: Non-sparing and sparing NVB treatment plans, delivered in 5 × 7.25 Gy, were automatically generated for 20 patients. Polynomial Chaos Expansion (PCE) was used to fast and accurately model the dose against treatment errors. PCE enabled a robustness evaluation of 100.000 treatment scenarios per plan, allowing to derive scenario distributions of clinically relevant dose volume histogram parameters and population dose histograms. Results: An average decrease of 3.7 Gy and 4.4 Gy in the median D0.1cm3 of the NVB was achieved in the patient population in the presence of realistic treatment uncertainties for non-coplanar (NC) and coplanar (C) plans respectively. Sparing NVBs decreased planning target volume coverage by 2.1 % in V36.25Gy on average, however clinical target volume (CTV) dose remained adequate. Population dose histograms showed that, while sparing does impact dose volume histogram parameters of organs at risk (OARs), the probability of a scenario exceeding planning constraints was limited. Conclusion: NVB sparing was maintained in the presence of treatment uncertainties without compromising CTV coverage or OAR dose. There was no significant difference in the achieved NVB dose between NC and C plans. The clinical impact of the achieved sparing is subject of ongoing clinical trials. |
| format | Article |
| id | doaj-art-605f63068ddb4755b1d30ced24eea8db |
| institution | Kabale University |
| issn | 2405-6316 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Physics and Imaging in Radiation Oncology |
| spelling | doaj-art-605f63068ddb4755b1d30ced24eea8db2025-02-04T04:10:29ZengElsevierPhysics and Imaging in Radiation Oncology2405-63162025-01-0133100714Neurovascular bundle sparing in hypofractionated radiotherapy maintained with realistic treatment uncertaintiesRoel C. Kwakernaak0Victor J. Brand1Jesús Rojo-Santiago2Femke E. Froklage3Mischa S. Hoogeman4Steven J.M. Habraken5Maaike T.W. Milder6Erasmus MC Cancer Institute University Medical Center Rotterdam Department of Radiotherapy the NetherlandsErasmus MC Cancer Institute University Medical Center Rotterdam Department of Radiotherapy the NetherlandsErasmus MC Cancer Institute University Medical Center Rotterdam Department of Radiotherapy the NetherlandsErasmus MC Cancer Institute University Medical Center Rotterdam Department of Radiotherapy the NetherlandsErasmus MC Cancer Institute University Medical Center Rotterdam Department of Radiotherapy the NetherlandsErasmus MC Cancer Institute University Medical Center Rotterdam Department of Radiotherapy the NetherlandsCorresponding author.; Erasmus MC Cancer Institute University Medical Center Rotterdam Department of Radiotherapy the NetherlandsBackground and purpose: Erectile dysfunction is a common side effect of radiotherapy for prostate cancer. To mitigate this toxicity, it has been suggested to limit the dose to critical nerves and vessels. We investigated the feasibility of sparing the neuro-vascular bundles (NVBs) in stereotactic body radiotherapy under the impact of realistic treatment uncertainties. Materials and methods: Non-sparing and sparing NVB treatment plans, delivered in 5 × 7.25 Gy, were automatically generated for 20 patients. Polynomial Chaos Expansion (PCE) was used to fast and accurately model the dose against treatment errors. PCE enabled a robustness evaluation of 100.000 treatment scenarios per plan, allowing to derive scenario distributions of clinically relevant dose volume histogram parameters and population dose histograms. Results: An average decrease of 3.7 Gy and 4.4 Gy in the median D0.1cm3 of the NVB was achieved in the patient population in the presence of realistic treatment uncertainties for non-coplanar (NC) and coplanar (C) plans respectively. Sparing NVBs decreased planning target volume coverage by 2.1 % in V36.25Gy on average, however clinical target volume (CTV) dose remained adequate. Population dose histograms showed that, while sparing does impact dose volume histogram parameters of organs at risk (OARs), the probability of a scenario exceeding planning constraints was limited. Conclusion: NVB sparing was maintained in the presence of treatment uncertainties without compromising CTV coverage or OAR dose. There was no significant difference in the achieved NVB dose between NC and C plans. The clinical impact of the achieved sparing is subject of ongoing clinical trials.http://www.sciencedirect.com/science/article/pii/S2405631625000193 |
| spellingShingle | Roel C. Kwakernaak Victor J. Brand Jesús Rojo-Santiago Femke E. Froklage Mischa S. Hoogeman Steven J.M. Habraken Maaike T.W. Milder Neurovascular bundle sparing in hypofractionated radiotherapy maintained with realistic treatment uncertainties Physics and Imaging in Radiation Oncology |
| title | Neurovascular bundle sparing in hypofractionated radiotherapy maintained with realistic treatment uncertainties |
| title_full | Neurovascular bundle sparing in hypofractionated radiotherapy maintained with realistic treatment uncertainties |
| title_fullStr | Neurovascular bundle sparing in hypofractionated radiotherapy maintained with realistic treatment uncertainties |
| title_full_unstemmed | Neurovascular bundle sparing in hypofractionated radiotherapy maintained with realistic treatment uncertainties |
| title_short | Neurovascular bundle sparing in hypofractionated radiotherapy maintained with realistic treatment uncertainties |
| title_sort | neurovascular bundle sparing in hypofractionated radiotherapy maintained with realistic treatment uncertainties |
| url | http://www.sciencedirect.com/science/article/pii/S2405631625000193 |
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