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@ARTICLE{Khouya:301477,
      author       = {A. Khouya and A. Santiago and T. Ringbaek and N.
                      Guberina$^*$ and M. Guberina$^*$ and T. Gauler and W.
                      Lübcke and W. Zylka and C. Pöttgen$^*$ and M.
                      Stuschke$^*$},
      title        = {{A}re treatment plans optimized on the basis of acuros {XB}
                      dose calculation robust against anatomic changes during
                      online adaptive radiotherapy for lung cancer regarding dose
                      homogeneity?},
      journal      = {Radiation oncology},
      volume       = {20},
      number       = {1},
      issn         = {1748-717X},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {DKFZ-2025-01019},
      pages        = {75},
      year         = {2025},
      abstract     = {The Acuros XB dose calculation algorithm implements
                      advanced modelling of lateral electron transport, making
                      dose distributions sensitive to density changes between
                      source and subsequent CT. The aim of this study was to
                      analyse the robustness of dose distribution in the central
                      bronchial wall (CBW) of treatment plans from lung cancer
                      patients treated with adaptive radiotherapy.IMRT or VMAT
                      plans from patients with locally advanced lung cancer from a
                      prospective registry cohort were analysed, who received
                      definitive radiotherapy in surface-guided inspiratory
                      breath-hold on the Ethos™ closed-bore linac, equipped with
                      the HyperSight™ cone beam CT (CBCT). Dose homogeneity of
                      the scheduled plans, optimized on planning CT (CTplan), was
                      verified on the initial CBCT of a dose fraction (CBCT1). The
                      adaptive plans were verified on a subsequent post-adaptation
                      CBCT (CBCT2) of the same dose fraction. A predictive model
                      was built for maximum dose (Dmax) in CBW in dependence on
                      plan sensitivity in the central bronchial air lumen
                      overlapping the planning target volume (CBALPTV) to water
                      override (WOR) of the air lumen.Ninety-one dose-fractions
                      from 10 patients were analysed. Dmax values in the CBW of
                      the scheduled plans showed over all significant
                      inter-fractional increases from CTplan to subsequent CBCT1
                      (p < 0.0001, Wilcoxon test, stratified by patient) with
                      significant heterogeneity between patients (p < 0.0001,
                      Kruskal-Wallis Test). The median Dmax increase per dose
                      fraction was $2.15\%$ (-3.15 - $19.30\%).$ Reducing the PTV
                      overlap of scheduled plans with CBAL led to lower
                      inter-fractional Dmax increases in CBW (p < 0.0001, signed
                      rank test). Dose accumulation showed, that Dmax and D1cc
                      values in CBW over the treatment course stayed in all
                      patients below $110.5\%$ and $107.5\%$ and that the
                      equivalent uniform dose in CTV around the CBW stayed >
                      $95\%$ for scheduled plans. A predictive model showed the
                      dependence of inter-fractional Dmax increases in CBW of
                      scheduled plans on an interaction between plan sensitivity
                      on CTplan to WOR in CBALPTV and density change at the Dmax
                      point in CBCT1 between CTplan and CBCT1 (p < 0.0001,
                      t-test). Intra-fractional Dmax increases of adaptive plans
                      in CBW amounted to only $20\%$ +/- $1.1\%$ of the
                      inter-fractional increases of scheduled plans, as
                      intra-fractional deformations were smaller than
                      inter-fractional (p < 0.0001, signed rank test).Dose
                      homogeneity in CBW of Ethos plans were found sufficiently
                      robust against intra-fractional deformations during course
                      of online adaptive radiotherapy. Plan sensitivity to
                      anatomic changes can be detected and controlled on the
                      planning CT by the WOR of air in CBALPTV.},
      keywords     = {Humans / Radiotherapy Planning, Computer-Assisted: methods
                      / Lung Neoplasms: radiotherapy / Lung Neoplasms: pathology /
                      Radiotherapy, Intensity-Modulated: methods / Radiotherapy
                      Dosage / Cone-Beam Computed Tomography: methods / Algorithms
                      / Prospective Studies / Male / Organs at Risk: radiation
                      effects / Female / Aged / Middle Aged},
      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:40375212},
      pmc          = {pmc:PMC12082940},
      doi          = {10.1186/s13014-025-02656-1},
      url          = {https://inrepo02.dkfz.de/record/301477},
}