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. 2022 Jul 28:23:103-108.
doi: 10.1016/j.phro.2022.07.005. eCollection 2022 Jul.

Technical feasibility of online adaptive stereotactic treatments in the abdomen on a robotic radiosurgery system

Maaike T W Milder  1 , Alba Magallon-Baro  1 , Wilhelm den Toom  1 , Erik de Klerck  1 , Lorne Luthart  1 , Joost J Nuyttens  1 , Mischa S Hoogeman  1
Affiliations

Technical feasibility of online adaptive stereotactic treatments in the abdomen on a robotic radiosurgery system

Maaike T W Milder et al. Phys Imaging Radiat Oncol. .

Abstract

Background and purpose: Stereotactic body radiotherapy (SBRT) has been proven to be beneficial for several disease sites in the (lower) abdomen. However, the quality of the treatment plan, based on a single planning computed tomography (CT), can be compromised due to large inter-fraction motion of the target and organs at risk (OARs) in this anatomical region. The aim of this study was to investigate the feasibility of online adaptive SBRT treatments on a robotic radiosurgery system and to record estimated total treatment times.

Materials and methods: For two disease sites, locally advanced pancreatic cancer (LAPC) and oligometastatic lymph nodes, four patients with repeat CTs were included in the feasibility study. Quick treatment plan templates were generated based on the planning CT and validated by running them on the plan and fraction CTs. For two cases a dummy run was performed and the individual steps were timed. Dose delivery was the largest contributor to the total treatment time, followed by contour adaptation.

Results: Running the quick plan templates resulted in plans similar to unrestricted plans, obeying the OAR constraints. The dummy runs showed that online adaptive treatments were completed in 64 to 83 min respectively for oligometastases and LAPC, comparable to other clinically available solutions.

Conclusions: This study showed the feasibility of online re-planning for two challenging disease sites within a clinically acceptable time frame on a robotic radiosurgery system, making use of commercially available elements that are not integrated by the vendor.

Keywords: ART; Adaptive; CyberKnife; LAPC; Oligometastases; SBRT.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The Erasmus MC Cancer Institute has research collaborations with Elekta AB, Stockholm, Sweden and Accuray Inc, Sunnyvale, USA, and Varian, Paolo Alto, USA.

Figures

Fig. 1
Fig. 1
Offline procedure and the different steps of the online adaptive procedure. In the online procedure several steps occur in parallel. The respective timings of the individual steps is different for the two tumour sites. Patient set-up and 3D imaging was performed once. Contour propagation and adaptation was performed one time for both sites. Plan optimization and treatment set-up time and delivery are average times over the patients included in this study. The DRR generation is a population average for the respective tracking type.
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