Online adaptive radiotherapy for head and neck cancers on the MR linear Accelerator: Introducing a novel modified Adapt-to-Shape approach

Introduction: The Elekta Unity MR-Linac (MRL) has enabled adaptive radiotherapy (ART) for patients with head and neck cancers (HNC). Adapt-To-Shape-Lite (ATS-Lite) is a novel Adapt-to-Shape strategy that provides ART without requiring daily clinician presence to perform online target and organ at ri...

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Autores principales:	Amit Gupta, Alex Dunlop, Adam Mitchell, Dualta McQuaid, Simeon Nill, Helen Barnes, Kate Newbold, Chris Nutting, Shreerang Bhide, Uwe Oelfke, Kevin Joseph Harrington, Kee Howe Wong
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2022
Materias:	Head and Neck Neoplasms Adaptive Radiotherapy MR-guided Radiotherapy MR-Linac Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/2cec4f7681cd44ad930a1db2dc15d89a
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spelling	oai:doaj.org-article:2cec4f7681cd44ad930a1db2dc15d89a2021-11-22T04:27:28ZOnline adaptive radiotherapy for head and neck cancers on the MR linear Accelerator: Introducing a novel modified Adapt-to-Shape approach2405-630810.1016/j.ctro.2021.11.001https://doaj.org/article/2cec4f7681cd44ad930a1db2dc15d89a2022-01-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2405630821000926https://doaj.org/toc/2405-6308Introduction: The Elekta Unity MR-Linac (MRL) has enabled adaptive radiotherapy (ART) for patients with head and neck cancers (HNC). Adapt-To-Shape-Lite (ATS-Lite) is a novel Adapt-to-Shape strategy that provides ART without requiring daily clinician presence to perform online target and organ at risk (OAR) delineation. In this study we compared the performance of our clinically-delivered ATS-Lite strategy against three Adapt-To-Position (ATP) variants: Adapt Segments (ATP-AS), Optimise Weights (ATP-OW), and Optimise Shapes (ATP-OS). Methods: Two patients with HNC received radical-dose radiotherapy on the MRL. For each fraction, an ATS-Lite plan was generated online and delivered and additional plans were generated offline for each ATP variant. To assess the clinical acceptability of a plan for every fraction, twenty clinical goals for targets and OARs were assessed for all four plans. Results: 53 fractions were analysed. ATS-Lite passed 99.9% of mandatory dose constraints. ATP-AS and ATP-OW each failed 7.6% of mandatory dose constraints. The Planning Target Volumes for 54 Gy (D95% and D98%) were the most frequently failing dose constraint targets for ATP. ATS-Lite median fraction times for Patient 1 and 2 were 40 mins 9 s (range 28 mins 16 s – 47 mins 20 s) and 32 mins 14 s (range 25 mins 33 s – 44 mins 27 s), respectively. Conclusions: Our early data show that the novel ATS-Lite strategy produced plans that fulfilled 99.9% of clinical dose constraints in a time frame that is tolerable for patients and comparable to ATP workflows. Therefore, ATS-Lite, which bridges the gap between ATP and full ATS, will be further utilised and developed within our institute and it is a workflow that should be considered for treating patients with HNC on the MRL.Amit GuptaAlex DunlopAdam MitchellDualta McQuaidSimeon NillHelen BarnesKate NewboldChris NuttingShreerang BhideUwe OelfkeKevin Joseph HarringtonKee Howe WongElsevierarticleHead and Neck NeoplasmsAdaptive RadiotherapyMR-guided RadiotherapyMR-LinacMedical physics. Medical radiology. Nuclear medicineR895-920Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENClinical and Translational Radiation Oncology, Vol 32, Iss , Pp 48-51 (2022)
institution	DOAJ
collection	DOAJ
language	EN
topic	Head and Neck Neoplasms Adaptive Radiotherapy MR-guided Radiotherapy MR-Linac Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Head and Neck Neoplasms Adaptive Radiotherapy MR-guided Radiotherapy MR-Linac Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Amit Gupta Alex Dunlop Adam Mitchell Dualta McQuaid Simeon Nill Helen Barnes Kate Newbold Chris Nutting Shreerang Bhide Uwe Oelfke Kevin Joseph Harrington Kee Howe Wong Online adaptive radiotherapy for head and neck cancers on the MR linear Accelerator: Introducing a novel modified Adapt-to-Shape approach
description	Introduction: The Elekta Unity MR-Linac (MRL) has enabled adaptive radiotherapy (ART) for patients with head and neck cancers (HNC). Adapt-To-Shape-Lite (ATS-Lite) is a novel Adapt-to-Shape strategy that provides ART without requiring daily clinician presence to perform online target and organ at risk (OAR) delineation. In this study we compared the performance of our clinically-delivered ATS-Lite strategy against three Adapt-To-Position (ATP) variants: Adapt Segments (ATP-AS), Optimise Weights (ATP-OW), and Optimise Shapes (ATP-OS). Methods: Two patients with HNC received radical-dose radiotherapy on the MRL. For each fraction, an ATS-Lite plan was generated online and delivered and additional plans were generated offline for each ATP variant. To assess the clinical acceptability of a plan for every fraction, twenty clinical goals for targets and OARs were assessed for all four plans. Results: 53 fractions were analysed. ATS-Lite passed 99.9% of mandatory dose constraints. ATP-AS and ATP-OW each failed 7.6% of mandatory dose constraints. The Planning Target Volumes for 54 Gy (D95% and D98%) were the most frequently failing dose constraint targets for ATP. ATS-Lite median fraction times for Patient 1 and 2 were 40 mins 9 s (range 28 mins 16 s – 47 mins 20 s) and 32 mins 14 s (range 25 mins 33 s – 44 mins 27 s), respectively. Conclusions: Our early data show that the novel ATS-Lite strategy produced plans that fulfilled 99.9% of clinical dose constraints in a time frame that is tolerable for patients and comparable to ATP workflows. Therefore, ATS-Lite, which bridges the gap between ATP and full ATS, will be further utilised and developed within our institute and it is a workflow that should be considered for treating patients with HNC on the MRL.
format	article
author	Amit Gupta Alex Dunlop Adam Mitchell Dualta McQuaid Simeon Nill Helen Barnes Kate Newbold Chris Nutting Shreerang Bhide Uwe Oelfke Kevin Joseph Harrington Kee Howe Wong
author_facet	Amit Gupta Alex Dunlop Adam Mitchell Dualta McQuaid Simeon Nill Helen Barnes Kate Newbold Chris Nutting Shreerang Bhide Uwe Oelfke Kevin Joseph Harrington Kee Howe Wong
author_sort	Amit Gupta
title	Online adaptive radiotherapy for head and neck cancers on the MR linear Accelerator: Introducing a novel modified Adapt-to-Shape approach
title_short	Online adaptive radiotherapy for head and neck cancers on the MR linear Accelerator: Introducing a novel modified Adapt-to-Shape approach
title_full	Online adaptive radiotherapy for head and neck cancers on the MR linear Accelerator: Introducing a novel modified Adapt-to-Shape approach
title_fullStr	Online adaptive radiotherapy for head and neck cancers on the MR linear Accelerator: Introducing a novel modified Adapt-to-Shape approach
title_full_unstemmed	Online adaptive radiotherapy for head and neck cancers on the MR linear Accelerator: Introducing a novel modified Adapt-to-Shape approach
title_sort	online adaptive radiotherapy for head and neck cancers on the mr linear accelerator: introducing a novel modified adapt-to-shape approach
publisher	Elsevier
publishDate	2022
url	https://doaj.org/article/2cec4f7681cd44ad930a1db2dc15d89a
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Online adaptive radiotherapy for head and neck cancers on the MR linear Accelerator: Introducing a novel modified Adapt-to-Shape approach

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