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@ARTICLE{HoegenSamannshausen:301320,
      author       = {P. Hoegen-Saßmannshausen$^*$ and T. P. Hartschuh and C. K.
                      Renkamp and C. Buchele and F. Schlüter and E. Sandrini and
                      F. Weykamp$^*$ and S. Regnery and E. Meixner and L. König
                      and J. Debus$^*$ and S. Klüter and J. Hörner-Rieber$^*$},
      title        = {{I}ntrafractional {M}otion in {O}nline-{A}daptive
                      {M}agnetic {R}esonance-{G}uided {R}adiotherapy of {A}drenal
                      {M}etastases {L}eads to {R}educed {T}arget {V}olume
                      {C}overage and {E}levated {O}rgan-at-{R}isk {D}oses.},
      journal      = {Cancers},
      volume       = {17},
      number       = {9},
      issn         = {2072-6694},
      address      = {Basel},
      publisher    = {MDPI},
      reportid     = {DKFZ-2025-00992},
      pages        = {1533},
      year         = {2025},
      note         = {#EA:E050#LA:E050#},
      abstract     = {Stereotactic body radiotherapy is frequently used in
                      patients with adrenal metastases. Motion of adherent
                      radiosensitive organs at risk (OARs) and tumors influence
                      OAR toxicity and tumor control. Online-adaptive Magnetic
                      Resonance-guided radiotherapy (MRgRT) can address and
                      mitigate interfractional changes. However, the impact of
                      intrafractional variations in adrenal MRgRT is unknown.A
                      total of 23 patients with 24 adrenal metastases were treated
                      with MRgRT. After daily plan adaptation and before beam
                      application, an additional (preRT) 3d MRI was acquired.
                      PreRT target volumes and OARs were retrospectively
                      recontoured in 200 fractions. The delivered, online-adapted
                      treatment plans, as well as non-adapted baseline plans, were
                      calculated on these re-contoured structures to quantify the
                      dosimetric impact of intrafractional variations on target
                      volume coverage and OAR doses with and without online
                      adaptation. Normal tissue complication probabilities (NTCPs)
                      were calculated.The median time between the two MRIs was
                      56.4 min. GTV and PTV coverage (dose to $95\%$ of the PTV,
                      $D95\%,$ and volume covered by $100\%$ of the prescription
                      dose, $V100\%)$ were significantly inferior in the preRT
                      plans. GTV Dmean was significantly impaired in left-sided
                      metastases, but not in right-sided metastases. Compared to
                      non-adapted preRT plans, adapted preRT plans were still
                      significantly superior for all GTV and PTV metrics.
                      Intrafractional violations of OAR constraints were frequent.
                      D0.5cc and the volume exposed to the near-maximum dose
                      constraint were significantly higher in the preRT plans. The
                      volume exposed to the D0.5cc constraints in single fractions
                      escalated up to 1.5 cc for the esophagus, 3.2 cc for the
                      stomach, 5.3 cc for the duodenum and 7.3 cc for the bowel.
                      This led to significantly elevated NTCPs for the stomach,
                      bowel and duodenum. Neither PTV $D95\%,$ nor
                      gastrointestinal OAR maximum doses were significantly
                      impaired by longer fraction duration.Intrafractional motion
                      in adrenal MRgRT caused significant impairment of target
                      volume coverage $(D95\%$ and $V100\%),$ potentially
                      undermining local control. Frequent violation of
                      gastrointestinal OAR constraints led to elevated NTCP.
                      Compared to non-adaptive treatment, online adaptation still
                      highly improved GTV and PTV coverage.},
      keywords     = {MR-linac (Other) / SABR (Other) / SBRT (Other) / drift
                      (Other) / gating (Other) / intrafractional changes (Other) /
                      oligometastasis (Other) / peristalsis (Other)},
      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},
      pubmed       = {pmid:40361458},
      doi          = {10.3390/cancers17091533},
      url          = {https://inrepo02.dkfz.de/record/301320},
}