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000178677 1001_ $$0P:(DE-He78)f4c0be14a7bb58948e5800ccdcbfe9bc$$aRegnery, Sebastian$$b0$$eFirst author$$udkfz
000178677 245__ $$aAdaptive MR-Guided Stereotactic Radiotherapy is Beneficial for Ablative Treatment of Lung Tumors in High-Risk Locations.
000178677 260__ $$aLausanne$$bFrontiers Media$$c2022
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000178677 520__ $$aTo explore the benefit of adaptive magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) for treatment of lung tumors in different locations with a focus on ultracentral lung tumors (ULT).A prospective cohort of 21 patients with 23 primary and secondary lung tumors was analyzed. Tumors were located peripherally (N = 10), centrally (N = 2) and ultracentrally (N = 11, planning target volume (PTV) overlap with proximal bronchi, esophagus and/or pulmonary artery). All patients received MRgSBRT with gated dose delivery and risk-adapted fractionation. Before each fraction, the baseline plan was recalculated on the anatomy of the day (predicted plan). Plan adaptation was performed in 154/165 fractions (93.3%). Comparison of dose characteristics between predicted and adapted plans employed descriptive statistics and Bayesian linear multilevel models. The posterior distributions resulting from the Bayesian models are presented by the mean together with the corresponding 95% compatibility interval (CI).Plan adaptation decreased the proportion of fractions with violated planning objectives from 94% (predicted plans) to 17% (adapted plans). In most cases, inadequate PTV coverage was remedied (predicted: 86%, adapted: 13%), corresponding to a moderate increase of PTV coverage (mean +6.3%, 95% CI: [5.3-7.4%]) and biologically effective PTV doses (BED10) (BEDmin: +9.0 Gy [6.7-11.3 Gy], BEDmean: +1.4 Gy [0.8-2.1 Gy]). This benefit was smaller in larger tumors (-0.1%/10 cm³ PTV [-0.2 to -0.02%/10 cm³ PTV]) and ULT (-2.0% [-3.1 to -0.9%]). Occurrence of exceeded maximum doses inside the PTV (predicted: 21%, adapted: 4%) and violations of OAR constraints (predicted: 12%, adapted: 1%, OR: 0.14 [0.04-0.44]) was effectively reduced. OAR constraint violations almost exclusively occurred if the PTV had touched the corresponding OAR in the baseline plan (18/19, 95%).Adaptive MRgSBRT is highly recommendable for ablative treatment of lung tumors whose PTV initially contacts a sensitive OAR, such as ULT. Here, plan adaptation protects the OAR while maintaining best-possible PTV coverage.
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000178677 650_7 $$2Other$$aMR-guided radiotherapy
000178677 650_7 $$2Other$$aimage-guidance
000178677 650_7 $$2Other$$amagnetic resonance imaging
000178677 650_7 $$2Other$$apulmonary cancer
000178677 650_7 $$2Other$$aradiotherapy
000178677 650_7 $$2Other$$astereotactic body radiotherapy
000178677 7001_ $$aBuchele, Carolin$$b1
000178677 7001_ $$aWeykamp, Fabian$$b2
000178677 7001_ $$aPohl, Moritz$$b3
000178677 7001_ $$0P:(DE-He78)a8a8a2fe0df558db50514c1b568ca8ff$$aHoegen, Philipp$$b4$$udkfz
000178677 7001_ $$aEichkorn, Tanja$$b5
000178677 7001_ $$aHeld, Thomas$$b6
000178677 7001_ $$aRistau, Jonas$$b7
000178677 7001_ $$aRippke, Carolin$$b8
000178677 7001_ $$aKönig, Laila$$b9
000178677 7001_ $$aThomas, Michael$$b10
000178677 7001_ $$aWinter, Hauke$$b11
000178677 7001_ $$0P:(DE-HGF)0$$aAdeberg, Sebastian$$b12
000178677 7001_ $$0P:(DE-He78)8714da4e45acfa36ce87c291443a9218$$aDebus, Jürgen$$b13$$udkfz
000178677 7001_ $$aKlüter, Sebastian$$b14
000178677 7001_ $$0P:(DE-He78)c59ff25b48c192ed3fd4ad3a4bc9b9c0$$aHörner-Rieber, Juliane$$b15$$eLast author$$udkfz
000178677 773__ $$0PERI:(DE-600)2649216-7$$a10.3389/fonc.2021.757031$$gVol. 11, p. 757031$$p757031$$tFrontiers in oncology$$v11$$x2234-943X$$y2022
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