Abstract
Purpose:To present a novel positioning strategy which optimizes radiation delivery with radiobiological response knowledge, and to evaluate its application during prostate external beam radiotherapy.Methods:Ten patients with low or intermediate risk prostate cancer were evaluated retrospectively in this IRB‐approved study. For each patient, a VMAT plan was generated on the planning CT (PCT) to deliver 78 Gy in 39 fractions with PTV = prostate + 7 mm margin, except for 5mm in the posterior direction. Five representative pretreatment CBCT images were selected for each patient, and prostate, rectum, and bladder were delineated on all CBCT images. Each CBCT was auto‐registered to the corresponding PCT. Starting from this auto‐matched position (AM‐position), a search for optimal treatment position was performed utilizing a score function based on radiobiological and dosimetric indices (D98_DTV, NTCP_rectum, and NTCP_bladder) for the daily target volume (DTV), rectum, and bladder. DTV was defined as prostate + 4 mm margin to account for intra‐fraction motion as well as contouring variability on CBCT. We termed the optimal treatment position the radiobiologically optimized couch shift position (ROCS‐position).Results:The indices, averaged over the 10 patients’ treatment plans, were (mean±SD): 77.7±0.2 Gy (D98_PTV), 12.3±2.7% (NTCP_rectum), and 53.2±11.2% (NTCP_bladder). The corresponding values calculated on all 50 CBCT images at the AM‐positions were 72.9±11.3 Gy (D98_DTV), 15.8±6.4% (NTCP_rectum), and 53.0±21.1% (NTCP_bladder), respectively. In comparison, calculated on CBCT at the ROCS‐positions, the indices were 77.0±2.1 Gy (D98_DTV), 12.1±5.7% (NTCP_rectum), and 60.7±16.4% (NTCP_bladder). Compared to autoregistration, ROCS‐optimization recovered dose coverage to target volume and lowered the risk to rectum. Moreover, NTCPrectum for one patient remained high after ROCS‐optimization and therefore could potentially benefit from adaptive planning.Conclusion:These encouraging results illustrate the potential utility of applying radiobiologically optimized correction for online image‐guided radiotherapy of prostate patients.
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