Academic Radiotherapy Unit, Institute of Cancer Research, London, UK.
Clin Oncol (R Coll Radiol). 2013 Sep;25(9):549-56. doi: 10.1016/j.clon.2013.06.001. Epub 2013 Jul 21.
Adaptive bladder radiotherapy, with plan of the day selection and plan library development based on individual filling patterns, has been previously modelled in patients receiving weekly hypofractionated treatment and improved geometric accuracy has been shown. The aim of this study was to assess the clinical implementation of the technique.
Conformal plans (with small, intermediate and large planning target volumes) were developed for 25 patients. After pre-treatment cone-beam computed tomography, the optimal plan of the day was selected and delivered by two trained observers. Independent off-line plan selection was also carried out. Concordance between the on-line and off-line selections, frequency of plan usage, target coverage and normal tissue sparing were assessed.
Plan selection concordance was 91%. Fifty-five per cent of fractions were delivered using small or large plans. The mean coverage of the clinical target volume by the 95% isodose was 99%. The mean reduction in the volume of normal tissue treated to 95% of the prescription dose was 219 cm(3) compared with the previous institutional standard approach.
Good concordance in plan selection is shown with clinical implementation of the adaptive strategy. Adequate target coverage was achieved with reduction in the volume of normal tissue irradiated to a high dose compared with the previous standard approach.
基于个体充盈模式的每日计划选择和计划库开发的自适应膀胱放疗，先前已在接受每周分割治疗的患者中进行建模，并且已经显示出更好的几何精度。本研究旨在评估该技术的临床实施情况。
为 25 名患者制定了适形计划（包括小、中、大计划靶区）。在治疗前锥形束 CT 后，由两名经过培训的观察者选择最佳的当日计划并进行治疗。还进行了独立的离线计划选择。评估了在线和离线选择之间的一致性、计划使用频率、靶区覆盖和正常组织保护。
计划选择的一致性为 91%。55%的分次采用小或大计划进行治疗。95%等剂量线覆盖临床靶区的平均覆盖率为 99%。与之前的机构标准方法相比，接受处方剂量 95%的正常组织体积减少了 219cm³。
自适应策略的临床实施显示出良好的计划选择一致性。与之前的标准方法相比，通过减少高剂量照射的正常组织体积，实现了足够的靶区覆盖。
