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Cuccia, Francesco; Rigo, Michele; Gurrera, Davide; Nicosia, Luca; Mazzola, Rosario; Figlia, Vanessa; Giaj-Levra, Niccolò; Ricchetti, Francesco; Attinà, Giorgio; Pastorello, Edoardo; De Simone, Antonio; Naccarato, Stefania; Sicignano, Gianluisa; Ruggieri, Ruggero; Alongi, Filippo
Journal of cancer research and clinical oncology, 11/2021, Volume: 147, Issue: 11Journal Article
Purpose We report preliminary dosimetric data concerning the use of 1.5-T MR-guided daily-adaptive radiotherapy for abdomino-pelvic lymph-nodal oligometastases. We aimed to assess the impact of this technology on mitigating daily variations for both target coverage and organs-at-risk (OARs) sparing. Methods A total of 150 sessions for 30 oligometastases in 23 patients were analyzed. All patients were treated with MR-guided stereotactic body radiotherapy (SBRT) for a total dose of 35 Gy in five fractions. For each fraction, a quantitative analysis was performed for PTV volume, V35Gy and D mean . Similarly, for OARs, we assessed daily variations of volume, D mean , D max . Any potential statistically significant change between baseline planning and daily-adaptive sessions was assessed using the Wilcoxon signed-rank test, assuming a p value < 0.05 as significant. Results Average baseline PTV, bowel, bladder, and single intestinal loop volumes were respectively 8.9 cc (range 0.7–41.2 cc), 1176 cc (119–3654 cc), 95 cc (39.7–202.9 cc), 18.3 cc (9.1–37.7 cc). No significant volume variations were detected for PTV ( p = 0.21) bowel ( p = 0.36), bladder ( p = 0.47), except for single intestinal loops, which resulted smaller ( p = 0.026). Average baseline V35Gy and D mean for PTV were respectively 85.6% (72–98.8%) and 35.6 Gy (34.6–36.1 Gy). We recorded a slightly positive trend in favor of daily-adaptive strategy vs baseline planning for improved target coverage, although not reaching statistical significance ( p = 0.11 and p = 0.18 for PTV-V35Gy and PTV- D mean ). Concerning OARs, a significant difference was observed in favor of daily-adapted treatments in terms of single intestinal loop D max 23.05 Gy (13.2–26.9 Gy) at baseline vs 20.5 Gy (12.1–24 Gy); p value = 0.0377 and D mean 14.4 Gy (6.5–18 Gy) at baseline vs 13.0 Gy (6.7–17.6 Gy); p value = 0.0003. Specifically for bladder, the average D max was 18.6 Gy (0.4–34.3 Gy) at baseline vs 18.3 Gy (0.7–34.3 Gy) for a p value = 0.28; the average D mean was 7.0 Gy (0.2–16.6 Gy) at baseline vs 6.98 Gy (0.2–16.4 Gy) for a p value = 0.66. Concerning the bowel, no differences in terms of D mean 4.78 Gy (1.3–10.9 Gy) vs 5.6 Gy (1.4–10.5 Gy); p value = 0.23 were observed between after daily-adapted sessions. A statistically significant difference was observed for bowel D max 26.4 Gy (7.7–34 Gy) vs 25.8 Gy (7.8–33.1 Gy); p value = 0.0086. Conclusions Daily-adaptive MR-guided SBRT reported a significantly improved single intestinal loop sparing for lymph-nodal oligometastases. Also, bowel D max was significantly reduced with daily-adaptive strategy. A minor advantage was also reported in terms of PTV coverage, although not statistically significant.
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