PMID- 38377378
OWN - NLM
STAT- Publisher
LR  - 20240220
IS  - 1526-9914 (Electronic)
IS  - 1526-9914 (Linking)
DP  - 2024 Feb 20
TI  - Technical feasibility of novel immunostimulatory low-dose radiation for 
      polymetastatic disease with CBCT-based online adaptive and conventional 
      approaches.
PG  - e14303
LID - 10.1002/acm2.14303 [doi]
AB  - PURPOSE: A workflow/planning strategy delivering low-dose radiation therapy 
      (LDRT) (1 Gy) to all polymetastatic diseases using conventional planning/delivery 
      (Raystation/Halcyon = "conventional") and the AI-based Ethos online adaptive RT 
      (oART) platform is developed/evaluated. METHODS: Using retrospective data for ten 
      polymetastatic non-small cell lung cancer patients (5-52 lesions each) with 
      PET/CTs, gross tumor volumes (GTVs) were delineated using PET 
      standardized-uptake-value (SUV) thresholding. A 1 cm uniform expansion of GTVs to 
      account for setup/contour uncertainty and organ motion-generated planning target 
      volumes (PTVs). Dose optimization/calculation used the diagnostic CT from PET/CT. 
      Dosimetric objectives were: D(min,0.03cc) >/= 95% (acceptable variation (Delta) >/= 90%), 
      V(100%) >/= 95% (Delta >/= 90%), and D(0.03cc) </= 120% (Delta </= 125%). Additionally, online 
      adaptation was simulated. When available, subsequent diagnostic CT was used to 
      represent on-treatment CBCT. Otherwise, the CT from PET/CT used for initial 
      planning was deformed to simulate clinically representative changes. RESULTS: All 
      initial plans generated, both for Raystation and Ethos, achieved clinical goals 
      within acceptable variation. For all patients, D(min,0.03cc) >/= 95%, V(100%) >/= 
      95%, and D(0.03cc) </= 120% goals were achieved for 84.8%/99.5%, 97.7%/98.7%, 
      97.4%/92.3%, in conventional/Ethos plans, respectively. The ratio of 50% isodose 
      volume to PTV volume (R(50%) ), maximum dose at 2 cm from PTV (D(2cm) ), and the 
      ratio of the 100% isodose volume to PTV volume (conformity index) in 
      Raystation/Ethos plans were 7.9/5.9; 102.3%/88.44%; and 0.99/1.01, respectively. 
      In Ethos, online adapted plans maintained PTV coverage whereas scheduled plans 
      often resulted in geographic misses due to changes in tumor size, patient 
      position, and body habitus. The average total duration of the oART workflow was 
      26:15 (min:sec) ranging from 6:43 to 57:30. The duration of each oART workflow 
      step as a function of a number of targets showed a low correlation coefficient 
      for influencer generation and editing (R(2 ) = 0.04 and 0.02, respectively) and 
      high correlation coefficient for target generation, target editing and plan 
      generation (R(2 ) = 0.68, 0.63 and 0.69, respectively). CONCLUSIONS: This study 
      demonstrates feasibility of conventional planning/treatment with 
      Raystation/Halcyon and highlights efficiency gains when utilizing semi-automated 
      planning/online-adaptive treatment with Ethos for immunostimulatory LDRT 
      conformally delivered to all sites of polymetastatic disease.
CI  - (c) 2024 The Authors. Journal of Applied Clinical Medical Physics published by 
      Wiley Periodicals, LLC on behalf of The American Association of Physicists in 
      Medicine.
FAU - Nasser, Nour
AU  - Nasser N
AD  - Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
AD  - Department of Physics, University of South Florida, Tampa, Florida, USA.
FAU - Perez, Bradford A
AU  - Perez BA
AD  - Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
FAU - Penagaricano, Jose A
AU  - Penagaricano JA
AD  - Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
FAU - Caudell, Jimmy J
AU  - Caudell JJ
AD  - Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
FAU - Oliver, Daniel E
AU  - Oliver DE
AD  - Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
FAU - Latifi, Kujtim
AU  - Latifi K
AD  - Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
FAU - Moros, Eduardo G
AU  - Moros EG
AD  - Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
FAU - Redler, Gage
AU  - Redler G
AD  - Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
LA  - eng
PT  - Journal Article
DEP - 20240220
PL  - United States
TA  - J Appl Clin Med Phys
JT  - Journal of applied clinical medical physics
JID - 101089176
SB  - IM
OTO - NOTNLM
OT  - adaptive therapy
OT  - development (new technology and techniques)
OT  - treatment planning/virtual clinical studies
EDAT- 2024/02/20 18:42
MHDA- 2024/02/20 18:42
CRDT- 2024/02/20 15:13
PHST- 2023/12/15 00:00 [revised]
PHST- 2023/11/07 00:00 [received]
PHST- 2024/02/02 00:00 [accepted]
PHST- 2024/02/20 18:42 [medline]
PHST- 2024/02/20 18:42 [pubmed]
PHST- 2024/02/20 15:13 [entrez]
AID - 10.1002/acm2.14303 [doi]
PST - aheadofprint
SO  - J Appl Clin Med Phys. 2024 Feb 20:e14303. doi: 10.1002/acm2.14303.