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000166609 1001_ $$0P:(DE-He78)a8a8a2fe0df558db50514c1b568ca8ff$$aHoegen, Philipp$$b0$$eFirst author$$udkfz
000166609 245__ $$aCone-Beam-CT Guided Adaptive Radiotherapy for Locally Advanced Non-small Cell Lung Cancer Enables Quality Assurance and Superior Sparing of Healthy Lung.
000166609 260__ $$aLausanne$$bFrontiers Media$$c2020
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000166609 520__ $$aTo evaluate the potential of cone-beam-CT (CB-CT) guided adaptive radiotherapy (ART) for locally advanced non-small cell lung cancer (NSCLC) for sparing of surrounding organs-at-risk (OAR).In 10 patients with locally advanced NSCLC, daily CB-CT imaging was acquired during radio- (n = 4) or radiochemotherapy (n = 6) for simulation of ART. Patients were treated with conventionally fractionated intensity-modulated radiotherapy (IMRT) with total doses of 60-66 Gy (pPlan) (311 fraction CB-CTs). OAR were segmented on every daily CB-CT and the tumor volumes were modified weekly depending on tumor changes. Doses actually delivered were recalculated on daily images (dPlan), and voxel-wise dose accumulation was performed using a deformable registration algorithm. For simulation of ART, treatment plans were adapted using the new contours and re-optimized weekly (aPlan).CB-CT showed continuous tumor regression of 1.1 ± 0.4% per day, leading to a residual gross tumor volume (GTV) of 65.3 ± 13.4% after 6 weeks of radiotherapy (p = 0.005). Corresponding PTVs decreased to 83.7 ± 7.8% (p = 0.005). In the actually delivered plans (dPlan), both conformity (p = 0.005) and homogeneity (p = 0.059) indices were impaired compared to the initial plans (pPlan). This resulted in higher actual lung doses than planned: V20Gy was 34.6 ± 6.8% instead of 32.8 ± 4.9% (p = 0.066), mean lung dose was 19.0 ± 3.1 Gy instead of 17.9 ± 2.5 Gy (p = 0.013). The generalized equivalent uniform dose (gEUD) of the lung was 18.9 ± 3.1 Gy instead of 17.8 ± 2.5 Gy (p = 0.013), leading to an increased lung normal tissue complication probability (NTCP) of 15.2 ± 13.9% instead of 9.6 ± 7.3% (p = 0.017). Weekly plan adaptation enabled decreased lung V20Gy of 31.6 ± 6.2% (-3.0%, p = 0.007), decreased mean lung dose of 17.7 ± 2.9 Gy (-1.3 Gy, p = 0.005), and decreased lung gEUD of 17.6 ± 2.9 Gy (-1.3 Gy, p = 0.005). Thus, resulting lung NTCP was reduced to 10.0 ± 9.5% (-5.2%, p = 0.005). Target volume coverage represented by conformity and homogeneity indices could be improved by weekly plan adaptation (CI: p = 0.007, HI: p = 0.114) and reached levels of the initial plan (CI: p = 0.721, HI: p = 0.333).IGRT with CB-CT detects continuous GTV and PTV changes. CB-CT-guided ART for locally advanced NSCLC is feasible and enables superior sparing of healthy lung at high levels of plan conformity.
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000166609 650_7 $$2Other$$aadaptive radiotherapy
000166609 650_7 $$2Other$$acone-beam computed tomography
000166609 650_7 $$2Other$$alung cancer
000166609 650_7 $$2Other$$anon-small cell lung cancer
000166609 650_7 $$2Other$$anormal tissue
000166609 650_7 $$2Other$$aorgans at risk
000166609 650_7 $$2Other$$apneumonitis
000166609 650_7 $$2Other$$aquality assessment
000166609 7001_ $$0P:(DE-He78)2c5517db7bc397f9b14ae357a7ce54ff$$aLang, Clemens$$b1$$udkfz
000166609 7001_ $$aAkbaba, Sati$$b2
000166609 7001_ $$0P:(DE-HGF)0$$aHäring, Peter$$b3
000166609 7001_ $$0P:(DE-He78)1f74df58d1c0f7b55b5caa01e6c7f806$$aSplinter, Mona$$b4$$udkfz
000166609 7001_ $$0P:(DE-He78)04bc7520e3c0a6bc9e9da40c02bf0f9c$$aMiltner, Annette$$b5$$udkfz
000166609 7001_ $$0P:(DE-He78)ff45bfd5f220fd946ef83485eeb8f2f6$$aBachmann, Marion$$b6$$udkfz
000166609 7001_ $$0P:(DE-He78)cec5a69186a0f7c800ab102ed800b6f2$$aStahl-Arnsberger, Christiane$$b7$$udkfz
000166609 7001_ $$0P:(DE-He78)7a69be9eb0e1c9e14864069804b1b82e$$aBrechter, Thomas$$b8$$udkfz
000166609 7001_ $$aEl Shafie, Rami A$$b9
000166609 7001_ $$aWeykamp, Fabian$$b10
000166609 7001_ $$aKönig, Laila$$b11
000166609 7001_ $$0P:(DE-He78)8714da4e45acfa36ce87c291443a9218$$aDebus, Jürgen$$b12$$udkfz
000166609 7001_ $$0P:(DE-He78)c59ff25b48c192ed3fd4ad3a4bc9b9c0$$aHörner-Rieber, Juliane$$b13$$eLast author$$udkfz
000166609 773__ $$0PERI:(DE-600)2649216-7$$a10.3389/fonc.2020.564857$$gVol. 10, p. 564857$$p564857$$tFrontiers in oncology$$v10$$x2234-943X$$y2020
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