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@ARTICLE{Hoegen:186557,
      author       = {P. Hoegen$^*$ and E. Katsigiannopulos and C. Buchele and S.
                      Regnery and F. Weykamp$^*$ and E. Sandrini and J. Ristau and
                      J. Liermann and E. Meixner and T. Forster and C. K. Renkamp
                      and F. Schlüter and C. Rippke and J. Debus$^*$ and S.
                      Klüter and J. Hörner-Rieber$^*$},
      title        = {{S}tereotactic magnetic resonance-guided online adaptive
                      radiotherapy of adrenal metastases combines high ablative
                      doses with optimized sparing of organs at risk},
      journal      = {Clinical and translational radiation oncology},
      volume       = {39},
      issn         = {2405-6308},
      address      = {Amsterdam},
      publisher    = {Elsevier},
      reportid     = {DKFZ-2023-00009},
      pages        = {100567},
      year         = {2023},
      note         = {#EA:E050#LA:E050#},
      abstract     = {Purpose/Objective: To evaluate the potential of
                      stereotactic magnetic resonance-guided online adaptive
                      radiotherapy (SMART) to fulfill dose recommendations for
                      stereotactic body radiotherapy (SBRT) of adrenal metastases
                      and spare organs at risk (OAR). Materials and methods: In
                      this subgroup analysis of a prospective registry trial, 22
                      patients with adrenal metastases were treated on a 0.35 T
                      MR-Linac in 5–12 fractions with fraction doses of 4–10
                      Gy. Baseline plans were re-calculated to the anatomy of the
                      day. These predicted plans were reoptimized to generate
                      adapted plans. Baseline, predicted and adapted plans were
                      compared with regard to PTV objectives, OAR constraints and
                      published dose recommendations. Results: The cohort
                      comprised patients with large GTV (median 36.0 cc) and PTV
                      (median 66.6 cc) and predominantly left-sided metastases.
                      179 of 181 fractions (98.9 $\%)$ were adapted because of PTV
                      and/or OAR violations. Predicted plans frequently violated
                      PTV coverage (99.4 $\%)$ and adjacent OAR constraints
                      (bowel: 32.9 $\%,$ stomach: 32.8 $\%,$ duodenum: 10.4 $\%,$
                      kidneys: 10.8 $\%).$ In the predicted plans, the volume
                      exposed to the maximum dose was exceeded up to 16-fold in
                      the duodenum and up to 96-fold in the spinal cord. Adapted
                      plans significantly reduced OAR violations by 96.4 $\%$ for
                      the bowel, 98.5 $\%$ for the stomach, 85.6 $\%$ for the
                      duodenum and 83.3 $\%$ for the kidneys. Plan adaptation
                      improved PTV coverage from 82.7 ± 8.1 $\%$ to 90.6 ± 4.9
                      $\%$ (p < 0.001). Furthermore, recently established target
                      volume thresholds could easily be fulfilled with SMART. No
                      toxicities > grade II occurred. Conclusion: SMART fulfills
                      established GTV and PTV dose recommendations while
                      simultaneously sparing organs at risk even in a challenging
                      cohort.},
      cin          = {E050 / HD01},
      ddc          = {610},
      cid          = {I:(DE-He78)E050-20160331 / I:(DE-He78)HD01-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      doi          = {10.1016/j.ctro.2022.100567},
      url          = {https://inrepo02.dkfz.de/record/186557},
}