Magnetic resonance guided adaptive post prostatectomy radiotherapy: Accumulated dose comparison of different workflows

Author:

Hassan Sean P.1,de Leon Jeremiah1,Batumalai Vikneswary12,Moutrie Zoe1234,Hogan Louise15,Ge Yuanyuan1,Stricker Phillip26789,Jameson Michael G.1210

Affiliation:

1. GenesisCare St Vincent's Hospital Sydney New South Wales Australia

2. Faculty of Medicine University of New South Wales Sydney New South Wales Australia

3. South Western Sydney Cancer Services New South Wales Health Sydney Australia

4. Ingham Institute for Applied Medical Research Sydney Australia

5. GenesisCare Murdoch Western Australia Australia

6. Western Sydney University Penrith New South Wales Australia

7. St Vincent's Prostate Cancer Research Centre Darlinghurst New South Wales Australia

8. Garvan Institute, Darlinghurst Sydney New South Wales Australia

9. University of Sydney Camperdown New South Wales Australia

10. Centre for Medical Radiation Physics University of Wollongong Wollongong Australia

Abstract

AbstractPurposeThe aim of this study was to assess the use of magnetic resonance guided adaptive radiotherapy (MRgART) in the post‐prostatectomy setting; comparing dose accumulation for our initial seven patients treated with fully adaptive workflow on the Unity MR‐Linac (MRL) and with non‐adaptive plans generated offline. Additionally, we analyzed toxicity in patients receiving treatment.MethodsSeven patients were treated with MRgART. The prescription was 70–72 Gy in 35–36 fractions. Patients were treated with an adapt to shape (ATS) technique. For each clinically delivered plan, a non‐adaptive plan based upon the reference plan was generated and compared to the associated clinically delivered plan. A total of 468 plans were analyzed. Concordance Index of target and Organs at Risk (OARs) for each fraction with reference contours was analyzed. Acute toxicity was then assessed at six‐months following completion of treatment with Common Terminology for Adverse Events (CTCAE) Toxicity Criteria.ResultsA total of 246 fractions were clinically delivered to seven patients; 234 fractions were delivered via MRgART and 12 fractions delivered via a traditional linear accelerator due to machine issues. Pre‐treatment reference plans met CTV and OAR criteria. PTV coverage satisfaction was higher in the clinically delivered adaptive plans than non‐adaptive comparison plans; 42.93% versus 7.27% respectively. Six‐month CTCAE genitourinary and gastrointestinal toxicity was absent in most patients, and mild‐to‐moderate in a minority of patients (Grade 1 GU toxicity in one patient and Grade 2 GI toxicity in one patient).ConclusionsDaily MRgART treatment consistently met planning criteria. Target volume variability in prostate bed treatment can be mitigated by using MRgART and deliver satisfactory coverage of CTV whilst minimizing dose to adjacent OARs and reducing toxicity

Publisher

Wiley

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