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@ARTICLE{Pttgen:285053,
      author       = {C. Pöttgen and C. Hoffmann and T. Gauler and M. Guberina
                      and N. Guberina and T. Ringbaek and A. Santiago Garcia and
                      U. Krafft and B. Hadaschik$^*$ and A. Khouya and M.
                      Stuschke$^*$},
      title        = {{F}ractionation versus {A}daptation for {C}ompensation of
                      {T}arget {V}olume {C}hanges during {O}nline {A}daptive
                      {R}adiotherapy for {B}ladder {C}ancer: {A}nswers from a
                      {P}rospective {R}egistry.},
      journal      = {Cancers},
      volume       = {15},
      number       = {20},
      issn         = {2072-6694},
      address      = {Basel},
      publisher    = {MDPI},
      reportid     = {DKFZ-2023-02196},
      pages        = {4933},
      year         = {2023},
      abstract     = {Online adaptive radiotherapy (ART) allows adaptation of the
                      dose distribution to the anatomy captured by with
                      pre-adaptation imaging. ART is time-consuming, and thus
                      intra-fractional deformations can occur. This prospective
                      registry study analyzed the effects of intra-fraction
                      deformations of clinical target volume (CTV) on the
                      equivalent uniform dose (EUDCTV) of focal bladder cancer
                      radiotherapy. Using margins of 5-10 mm around CTV on
                      pre-adaptation imaging, intra-fraction CTV-deformations
                      found in a second imaging study reduced the 10th percentile
                      of EUDCTV values per fraction from $101.1\%$ to $63.2\%$ of
                      the prescribed dose. Dose accumulation across fractions of a
                      series was determined with deformable-image registration and
                      worst-case dose accumulation that maximizes the correlation
                      of cold spots. A strong fractionation effect was
                      demonstrated-the EUDCTV was above $95\%$ and $92.5\%$ as
                      determined by the two abovementioned accumulation methods,
                      respectively, for all series of dose fractions. A comparison
                      of both methods showed that the fractionation effect caused
                      the EUDCTV of a series to be insensitive to EUDCTV-declines
                      per dose fraction, and this could be explained by the small
                      size and spatial variations of cold spots. Therefore, ART
                      for each dose fraction is unnecessary, and selective ART for
                      fractions with large inter-fractional deformations alone is
                      sufficient for maintaining a high EUDCTV for a radiotherapy
                      series.},
      keywords     = {bladder cancer (Other) / dose accumulation (Other) /
                      equivalent uniform dose (Other) / online adaptive
                      radiotherapy (Other)},
      cin          = {ED01},
      ddc          = {610},
      cid          = {I:(DE-He78)ED01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37894299},
      pmc          = {pmc:PMC10605897},
      doi          = {10.3390/cancers15204933},
      url          = {https://inrepo02.dkfz.de/record/285053},
}