Assessing intra- and interfraction motion and its dosimetric impacts on cervical cancer adaptive radiotherapy based on 1.5T MR-Linac
Abstract Purpose The purpose of this study was to quantify the intra- and interfraction motion of the target volume and organs at risk (OARs) during adaptive radiotherapy (ART) for uterine cervical cancer (UCC) using MR-Linac and to identify appropriate UCC target volume margins for adapt-to-shape (...
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BMC
2024-12-01
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| Series: | Radiation Oncology |
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| Online Access: | https://doi.org/10.1186/s13014-024-02569-5 |
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| author | Huadong Wang Zhenkai Li Dengxin Shi Peijun Yin Benzhe Liang Jingmin Zou Qiuqing Tao Wencheng Ma Yong Yin Zhenjiang Li |
| author_facet | Huadong Wang Zhenkai Li Dengxin Shi Peijun Yin Benzhe Liang Jingmin Zou Qiuqing Tao Wencheng Ma Yong Yin Zhenjiang Li |
| author_sort | Huadong Wang |
| collection | DOAJ |
| description | Abstract Purpose The purpose of this study was to quantify the intra- and interfraction motion of the target volume and organs at risk (OARs) during adaptive radiotherapy (ART) for uterine cervical cancer (UCC) using MR-Linac and to identify appropriate UCC target volume margins for adapt-to-shape (ATS) and adapt-to-position (ATP) workflows. Then, the dosimetric differences caused by motion were analyzed. Methods Thirty-two UCC patients were included. Magnetic resonance (MR) images were obtained before and after each treatment. The maximum and average shifts in the centroid of the target volume and OARs along the anterior/posterior (A/P: Y axes), cranial/caudal (Cr/C: Z axes), and right/left (R/L: X axes) directions were analyzed through image contours. The bladder wall deformation in six directions and the differences in the volume of the organs were also analyzed. Additionally, the motion of the upper, middle and lower rectum was quantified. The correlation between OAR displacement/deformation and target volume displacement was evaluated. The planning CT dose distribution was mapped to the MR image to generate a plan based on the new anatomy, and the dosimetric differences caused by motion were analyzed. Results For intrafraction motion, the clinical tumor volume (CTV) range of motion along the XYZ axes was within 5 mm; for interfraction motion, the range of motion along the X axis was within 5 mm, and the maximum distances of motion along the Y axis and Z axis were 7.45 and 6.59 mm, respectively. Additionally, deformation of the superior and anterior walls of the bladder was most noticeable. The largest magnitude of motion was observed in the upper segment of the rectum. Posterior bladder wall displacement was correlated with rectal and CTV centroid Y-axis displacement (r = 0.63, r = 0.50, P < 0.05). Compared with the interfractional plan, a significant decrease in the planning target volume (PTV) D98 (7.5 Gy, 7.54 Gy) was observed. However, there were no significant differences within the intrafraction. Conclusion During ART for UCC patients using MR-Linac, we recommend an ATS workflow using isotropic PTV margins of 5 mm based on intrafraction motion. Based on interfraction motion, the recommended ATP workflow uses anisotropic PTV margins of 5 mm in the R/L direction, 8 mm in the A/P direction, and 7 mm in the Cr/C direction to compensate for dosimetric errors due to motion. |
| format | Article |
| id | doaj-art-9ce71fba25aa4f6587a41560b7da9643 |
| institution | DOAJ |
| issn | 1748-717X |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj-art-9ce71fba25aa4f6587a41560b7da96432025-08-20T02:39:43ZengBMCRadiation Oncology1748-717X2024-12-0119111110.1186/s13014-024-02569-5Assessing intra- and interfraction motion and its dosimetric impacts on cervical cancer adaptive radiotherapy based on 1.5T MR-LinacHuadong Wang0Zhenkai Li1Dengxin Shi2Peijun Yin3Benzhe Liang4Jingmin Zou5Qiuqing Tao6Wencheng Ma7Yong Yin8Zhenjiang Li9Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesDepartment of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesDepartment of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesDepartment of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesDepartment of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesDepartment of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesDepartment of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesDepartment of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesDepartment of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesDepartment of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesAbstract Purpose The purpose of this study was to quantify the intra- and interfraction motion of the target volume and organs at risk (OARs) during adaptive radiotherapy (ART) for uterine cervical cancer (UCC) using MR-Linac and to identify appropriate UCC target volume margins for adapt-to-shape (ATS) and adapt-to-position (ATP) workflows. Then, the dosimetric differences caused by motion were analyzed. Methods Thirty-two UCC patients were included. Magnetic resonance (MR) images were obtained before and after each treatment. The maximum and average shifts in the centroid of the target volume and OARs along the anterior/posterior (A/P: Y axes), cranial/caudal (Cr/C: Z axes), and right/left (R/L: X axes) directions were analyzed through image contours. The bladder wall deformation in six directions and the differences in the volume of the organs were also analyzed. Additionally, the motion of the upper, middle and lower rectum was quantified. The correlation between OAR displacement/deformation and target volume displacement was evaluated. The planning CT dose distribution was mapped to the MR image to generate a plan based on the new anatomy, and the dosimetric differences caused by motion were analyzed. Results For intrafraction motion, the clinical tumor volume (CTV) range of motion along the XYZ axes was within 5 mm; for interfraction motion, the range of motion along the X axis was within 5 mm, and the maximum distances of motion along the Y axis and Z axis were 7.45 and 6.59 mm, respectively. Additionally, deformation of the superior and anterior walls of the bladder was most noticeable. The largest magnitude of motion was observed in the upper segment of the rectum. Posterior bladder wall displacement was correlated with rectal and CTV centroid Y-axis displacement (r = 0.63, r = 0.50, P < 0.05). Compared with the interfractional plan, a significant decrease in the planning target volume (PTV) D98 (7.5 Gy, 7.54 Gy) was observed. However, there were no significant differences within the intrafraction. Conclusion During ART for UCC patients using MR-Linac, we recommend an ATS workflow using isotropic PTV margins of 5 mm based on intrafraction motion. Based on interfraction motion, the recommended ATP workflow uses anisotropic PTV margins of 5 mm in the R/L direction, 8 mm in the A/P direction, and 7 mm in the Cr/C direction to compensate for dosimetric errors due to motion.https://doi.org/10.1186/s13014-024-02569-5MR-LinacCervical cancerAdaptive radiotherapyIntra- and interfraction motionDosimetric difference |
| spellingShingle | Huadong Wang Zhenkai Li Dengxin Shi Peijun Yin Benzhe Liang Jingmin Zou Qiuqing Tao Wencheng Ma Yong Yin Zhenjiang Li Assessing intra- and interfraction motion and its dosimetric impacts on cervical cancer adaptive radiotherapy based on 1.5T MR-Linac Radiation Oncology MR-Linac Cervical cancer Adaptive radiotherapy Intra- and interfraction motion Dosimetric difference |
| title | Assessing intra- and interfraction motion and its dosimetric impacts on cervical cancer adaptive radiotherapy based on 1.5T MR-Linac |
| title_full | Assessing intra- and interfraction motion and its dosimetric impacts on cervical cancer adaptive radiotherapy based on 1.5T MR-Linac |
| title_fullStr | Assessing intra- and interfraction motion and its dosimetric impacts on cervical cancer adaptive radiotherapy based on 1.5T MR-Linac |
| title_full_unstemmed | Assessing intra- and interfraction motion and its dosimetric impacts on cervical cancer adaptive radiotherapy based on 1.5T MR-Linac |
| title_short | Assessing intra- and interfraction motion and its dosimetric impacts on cervical cancer adaptive radiotherapy based on 1.5T MR-Linac |
| title_sort | assessing intra and interfraction motion and its dosimetric impacts on cervical cancer adaptive radiotherapy based on 1 5t mr linac |
| topic | MR-Linac Cervical cancer Adaptive radiotherapy Intra- and interfraction motion Dosimetric difference |
| url | https://doi.org/10.1186/s13014-024-02569-5 |
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