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@ARTICLE{Regnery:276330,
      author       = {S. Regnery and L. Leiner and C. Buchele and P. Hoegen$^*$
                      and E. Sandrini and T. Held and M. Deng and T. Eichkorn and
                      C. Rippke and C. K. Renkamp and L. König and K. Lang and S.
                      Adeberg and J. Debus$^*$ and S. Klüter and J.
                      Hörner-Rieber$^*$},
      title        = {{C}omparison of different dose accumulation strategies to
                      estimate organ doses after stereotactic magnetic
                      resonance-guided adaptive radiotherapy.},
      journal      = {Radiation oncology},
      volume       = {18},
      number       = {1},
      issn         = {1748-717X},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {DKFZ-2023-01060},
      pages        = {92},
      year         = {2023},
      note         = {#LA:E050#},
      abstract     = {Re-irradiation is frequently performed in the era of
                      precision oncology, but previous doses to organs-at-risk
                      (OAR) must be assessed to avoid cumulative overdoses.
                      Stereotactic magnetic resonance-guided online adaptive
                      radiotherapy (SMART) enables highly precise ablation of
                      tumors close to OAR. However, OAR doses may change
                      considerably during adaptive treatment, which complicates
                      potential re-irradiation. We aimed to compare the baseline
                      plan with different dose accumulation techniques to inform
                      re-irradiation.We analyzed 18 patients who received SMART to
                      lung or liver tumors inside prospective databases.
                      Cumulative doses were calculated inside the planning target
                      volumes (PTV) and OAR for the adapted plans and theoretical
                      non-adapted plans via (1) cumulative dose volume histograms
                      (DVH sum plan) and (2) deformable image registration
                      (DIR)-based dose accumulation to planning images (DIR sum
                      plan). We compared cumulative dose parameters between the
                      baseline plan, DVH sum plan and DIR sum plan using
                      equivalent doses in 2 Gy fractions (EQD2).Individual
                      patients presented relevant increases of near-maximum doses
                      inside the proximal bronchial tree, spinal cord, heart and
                      gastrointestinal OAR when comparing adaptive treatment to
                      the baseline plans. The spinal cord near-maximum doses were
                      significantly increased in the liver patients $(D2\%$
                      median: baseline 6.1 Gy, DIR sum 8.1 Gy, DVH sum 8.4 Gy, p =
                      0.04; D0.1 cm³ median: baseline 6.1 Gy, DIR sum 8.1 Gy, DVH
                      sum 8.5 Gy, p = 0.04). Three OAR overdoses occurred during
                      adaptive treatment (DIR sum: 1, DVH sum: 2), and four more
                      intense OAR overdoses would have occurred during
                      non-adaptive treatment (DIR sum: 4, DVH sum: 3). Adaptive
                      treatment maintained similar PTV coverages to the baseline
                      plans, while non-adaptive treatment yielded significantly
                      worse PTV coverages in the lung $(D95\%$ median: baseline
                      86.4 Gy, DIR sum 82.4 Gy, DVH sum 82.2 Gy, p = 0.006) and
                      liver patients $(D95\%$ median: baseline 87.4 Gy, DIR sum
                      82.1 Gy, DVH sum 81.1 Gy, p = 0.04).OAR doses can increase
                      during SMART, so that re-irradiation should be planned based
                      on dose accumulations of the adapted plans instead of the
                      baseline plan. Cumulative dose volume histograms represent a
                      simple and conservative dose accumulation strategy.},
      keywords     = {Deformable image Registration (Other) / Dose accumulation
                      (Other) / Image-guided Radiotherapy (IGRT) (Other) / Liver
                      Cancer (Other) / MR-guided adaptive radiotherapy (Other) /
                      Pulmonary Cancer (Other) / Stereotactic body Radiotherapy
                      (SABR) (Other)},
      cin          = {E050},
      ddc          = {610},
      cid          = {I:(DE-He78)E050-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37248504},
      doi          = {10.1186/s13014-023-02284-7},
      url          = {https://inrepo02.dkfz.de/record/276330},
}