Objectives Inter- and intra-fraction anatomical variations, both in the target and in the OARs, can pose a challenge for Radiation Oncologists, particularly in pelvic EBRT. Modern solutions include OART; however, there is limited evidence in the literature regarding its application in gynecological cancers. This manuscript reports our first clinical experience in radical (for LACC) and adjuvant (endometrial cancer) treatments delivered with CBCT-based Online-Adaptive RT. Materials and Methods Two patients (one treated with radical intent and one in the adjuvant setting) were treated on the Ethos™ platform. In order to compare an ITV-T-based approach (the current standard at our center) with OART, the planning CT was acquired with both full and empty bladder, using the full bladder scan as the reference for planning. For each patient, one OART plan was created and delivered, while a corresponding ITV-T-based plan was simulated. To compare the two techniques, doses were recalculated for each fraction on the synthetic CT generated from the pre-treatment CBCT. Dose-volume histograms (DVHs) were then analyzed. Gastrointestinal and genitourinary toxicities were monitored throughout the treatment period. Results OART improves CTV-T-D98% in both radical (HL: 10,12%; IC 95%: 4,88 - 13,41; Cohen's d: 0,84) and adjuvant treatment (HL: 12,36%; IC 95%: 5,81 - 16,29; Cohen's d: 1,08), both resulted in p-value < 0,05. No increase in OAR dose was observed, and no major radiation-related toxicities were reported in either patient. Conclusions OART improves target coverage, potentially leading to better disease control, without increasing the average dose to OARs or related toxicities. Moreover, OART allows for less stringent treatment preparation protocols, thereby improving patient comfort and compliance.
Obiettivi Le variazioni anatomiche inter- e intra- frazione, del target e degli organi a rischio, rappresentano una sfida per il Radio-Oncologo, in particolare nella EBRT della pelvi. Le soluzioni odierne includono l'OART, tuttavia, ci sono poche evidenze in letteratura riguardo il suo utilizzo per i tumori ginecologici. Questo elaborato riporta la nostra prima esperienza clinica nel trattamento di tumori ginecologici con intento radicale (per LACC) e adiuvante (carcinoma endometriale), utilizzando l'Online-Adaptive RT basata su CBCT. Materiali e Metodi Due pazienti sono state trattate su Ethos™ (una con intento radicale e una con intento adiuvante). Per confrontare le due tecniche, la TC-sim è stata acquisita con vescica piena e vuota, utilizzando quella a vescica piena come TC di pianificazione. Per ogni paziente, è stato generato ed erogato un piano in OART, mentre l’erogazione del piano basato su ITV-T è stata simulata. Per confrontare le due tecniche, le dosi sono state ricalcolate per ogni frazione sulla TC sintetica generata dalla CBCT pre-trattamento. Sono stati poi analizzati gli istogrammi dose-volume (DVHs). Le tossicità gastrointestinali e genito-urinarie sono state monitorate durante l’intero periodo di trattamento. Risultati L'OART sembra migliorare la CTV-T-D98% sia nel trattamento radicale (HL: 10,12%; IC 95%: 4,88 - 13,41; Cohen's d: 0,84) che in adiuvante (HL: 12,36%; IC 95%: 5,81 - 16,29; Cohen's d: 1,08) per entrambi gli scenari è risultato un p-value < 0,05. Non è stato registrato un aumento della dose agli OARs e non sono state registrate tossicità radio-relate. Conclusioni L'OART migliora la copertura del target, con potenziale beneficio sul controllo di malattia, senza aumentare la dose agli OARs o le tossicità radio-relate. Inoltre il trattamento in OART permette di essere meno rigidi sulla preparazione al trattamento, aumentando il comfort delle pazienti e di conseguenza la loro compliance al trattamento.
Vantaggi dosimetrici dell’ o-ART rispetto all’approccio con ITV nel trattamento radiante per le neoplasie ginecologiche.
MARTINO, FRANCESCO
2022/2023
Abstract
Objectives Inter- and intra-fraction anatomical variations, both in the target and in the OARs, can pose a challenge for Radiation Oncologists, particularly in pelvic EBRT. Modern solutions include OART; however, there is limited evidence in the literature regarding its application in gynecological cancers. This manuscript reports our first clinical experience in radical (for LACC) and adjuvant (endometrial cancer) treatments delivered with CBCT-based Online-Adaptive RT. Materials and Methods Two patients (one treated with radical intent and one in the adjuvant setting) were treated on the Ethos™ platform. In order to compare an ITV-T-based approach (the current standard at our center) with OART, the planning CT was acquired with both full and empty bladder, using the full bladder scan as the reference for planning. For each patient, one OART plan was created and delivered, while a corresponding ITV-T-based plan was simulated. To compare the two techniques, doses were recalculated for each fraction on the synthetic CT generated from the pre-treatment CBCT. Dose-volume histograms (DVHs) were then analyzed. Gastrointestinal and genitourinary toxicities were monitored throughout the treatment period. Results OART improves CTV-T-D98% in both radical (HL: 10,12%; IC 95%: 4,88 - 13,41; Cohen's d: 0,84) and adjuvant treatment (HL: 12,36%; IC 95%: 5,81 - 16,29; Cohen's d: 1,08), both resulted in p-value < 0,05. No increase in OAR dose was observed, and no major radiation-related toxicities were reported in either patient. Conclusions OART improves target coverage, potentially leading to better disease control, without increasing the average dose to OARs or related toxicities. Moreover, OART allows for less stringent treatment preparation protocols, thereby improving patient comfort and compliance.File | Dimensione | Formato | |
---|---|---|---|
Tesi Martino Francesco (1).pdf
accesso riservato
Dimensione
1.24 MB
Formato
Adobe PDF
|
1.24 MB | Adobe PDF |
The text of this website © Università degli studi di Padova. Full Text are published under a non-exclusive license. Metadata are under a CC0 License
https://hdl.handle.net/20.500.12608/85529