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. 2017 Dec;125(3):439-444.
doi: 10.1016/j.radonc.2017.07.028. Epub 2017 Aug 12.

Fast and robust online adaptive planning in stereotactic MR-guided adaptive radiation therapy (SMART) for pancreatic cancer

O Bohoudi  1 , A M E Bruynzeel  1 , S Senan  1 , J P Cuijpers  1 , B J Slotman  1 , F J Lagerwaard  1 , M A Palacios  2
Affiliations

Fast and robust online adaptive planning in stereotactic MR-guided adaptive radiation therapy (SMART) for pancreatic cancer

O Bohoudi et al. Radiother Oncol. 2017 Dec.

Abstract

Background and purpose: To implement a robust and fast stereotactic MR-guided adaptive radiation therapy (SMART) online strategy in locally advanced pancreatic cancer (LAPC).

Material and methods: SMART strategy for plan adaptation was implemented with the MRIdian system (ViewRay Inc.). At each fraction, OAR (re-)contouring is done within a distance of 3cm from the PTV surface. Online plan re-optimization is based on robust prediction of OAR dose and optimization objectives, obtained by building an artificial neural network (ANN). Proposed limited re-contouring strategy for plan adaptation (SMART3CM) is evaluated by comparing 50 previously delivered fractions against a standard (re-)planning method using full-scale OAR (re-)contouring (FULLOAR). Plan quality was assessed using PTV coverage (V95%, Dmean, D1cc) and institutional OAR constraints (e.g. V33Gy).

Results: SMART3CM required a significant lower number of optimizations than FULLOAR (4 vs 18 on average) to generate a plan meeting all objectives and institutional OAR constraints. PTV coverage with both strategies was identical (mean V95%=89%). Adaptive plans with SMART3CM exhibited significant lower intermediate and high doses to all OARs than FULLOAR, which also failed in 36% of the cases to adhere to the V33Gy dose constraint.

Conclusions: SMART3CM approach for LAPC allows good OAR sparing and adequate target coverage while requiring only limited online (re-)contouring from clinicians.

Keywords: Adaptive; MR-guided; Online; Pancreas; Planning; Stereotactic.

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Comment in

  • SBRT for pancreatic cancer: In regard of Bohoudi et al.
    Garibaldi C, Moretti E, Russo S, Talamonti C, Villaggi E, Mancosu P; Italian Medical Physicists SBRT Working Group. Garibaldi C, et al. Radiother Oncol. 2018 Jun;127(3):509-510. doi: 10.1016/j.radonc.2018.04.001. Epub 2018 May 3. Radiother Oncol. 2018. PMID: 29731159 No abstract available.
  • SBRT for pancreatic cancer: In regard of Bohoudi et al.
    Bohoudi O, Bruynzeel AM, Senan S, Cuijpers JP, Slotman BJ, Lagerwaard FJ, Palacios MA. Bohoudi O, et al. Radiother Oncol. 2018 Jun;127(3):511-512. doi: 10.1016/j.radonc.2018.04.024. Epub 2018 May 11. Radiother Oncol. 2018. PMID: 29759683 No abstract available.

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