RT Journal Article
T1 Selective sparing of bladder and rectum sub-regions in radiotherapy of prostate cancer combining knowledge-based automatic planning and multicriteria optimization
A1 Alborghetti, Lisa
A1 Castriconi, Roberta
A1 Sosa Marrero, Carlos
A1 Tudda, Alessia
A1 Ubeira-Gabellini, Maria Guiulia
A1 Broggi, Sara
A1 Pascau González-Garzón, Javier
A1 Cubero Gutierrez, Lucia
A1 Cozzarini, Cesare
A1 Crevoisier, Renaud De
A1 Rancati, Tiziana
A1 Acosta, Oscar
A1 Fiorino, Claudio
AB Background and Purpose: The association between dose to selected bladder and rectum symptom-related sub- regions (SRS) and late toxicity after prostate cancer radiotherapy has been evidenced by voxel-wise analyses. The aim of the current study was to explore the feasibility of combining knowledge-based (KB) and multi-criteria optimization (MCO) to spare SRSs without compromising planning target volume (PTV) dose delivery, including pelvic-node irradiation.Materials and Methods: Forty-five previously treated patients (74.2 Gy/28fr) were selected and SRSs (in the bladder, associated with late dysuria/hematuria/retention; in the rectum, associated with bleeding) were generated using deformable registration. A KB model was used to obtain clinically suitable plans (KB-plan). KB- plans were further optimized using MCO, aiming to reduce dose to the SRSs while safeguarding target dose coverage, homogeneity and avoiding worsening dose volume histograms of the whole bladder, rectum and other organs at risk. The resulting MCO-generated plans were examined to identify the best-compromise plan (KB + MCO-plan).Results: The mean SRS dose decreased in almost all patients for each SRS. D1% also decreased in the large majority, less frequently for dysuria/bleeding SRS. Mean differences were statistically significant (p < 0.05) and ranged between 1.3 and 2.2 Gy with maximum reduction of mean dose up to 3&#8211;5 Gy for the four SRSs. The better sparing of SRSs was obtained without compromising PTVs coverage.Conclusions: Selectively sparing SRSs without compromising PTV coverage is feasible and has the potential to reduce toxicities in prostate cancer radiotherapy. Further investigation to better quantify the expected risk reduction of late toxicities is warranted.
PB Elsevier
SN 2405-6316
YR 2023
FD 2023-10-01
LK https://hdl.handle.net/10016/39293
UL https://hdl.handle.net/10016/39293
LA eng
NO This work has been supported by Fondazione Regionale per la Ricerca Biomedica, project nr. 110 - JTC PerPlanRT ERA PerMed, GA 779282.
DS e-Archivo
RD 17 jul. 2024