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@ARTICLE{Hoegen:166609,
      author       = {P. Hoegen$^*$ and C. Lang$^*$ and S. Akbaba and P.
                      Häring$^*$ and M. Splinter$^*$ and A. Miltner$^*$ and M.
                      Bachmann$^*$ and C. Stahl-Arnsberger$^*$ and T. Brechter$^*$
                      and R. A. El Shafie and F. Weykamp and L. König and J.
                      Debus$^*$ and J. Hörner-Rieber$^*$},
      title        = {{C}one-{B}eam-{CT} {G}uided {A}daptive {R}adiotherapy for
                      {L}ocally {A}dvanced {N}on-small {C}ell {L}ung {C}ancer
                      {E}nables {Q}uality {A}ssurance and {S}uperior {S}paring of
                      {H}ealthy {L}ung.},
      journal      = {Frontiers in oncology},
      volume       = {10},
      issn         = {2234-943X},
      address      = {Lausanne},
      publisher    = {Frontiers Media},
      reportid     = {DKFZ-2020-03045},
      pages        = {564857},
      year         = {2020},
      note         = {#EA:E050#LA:E050#},
      abstract     = {To 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.},
      keywords     = {adaptive radiotherapy (Other) / cone-beam computed
                      tomography (Other) / lung cancer (Other) / non-small cell
                      lung cancer (Other) / normal tissue (Other) / organs at risk
                      (Other) / pneumonitis (Other) / quality assessment (Other)},
      cin          = {E050 / E040 / HD01},
      ddc          = {610},
      cid          = {I:(DE-He78)E050-20160331 / I:(DE-He78)E040-20160331 /
                      I:(DE-He78)HD01-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:33363005},
      pmc          = {pmc:PMC7756078},
      doi          = {10.3389/fonc.2020.564857},
      url          = {https://inrepo02.dkfz.de/record/166609},
}