Evidence map›Paper›PMID 38712917›Full record

ArticleJournal of applied clinical medical physics2024

Beyond conventional bounds: Surpassing system limits for stereotactic ablative (SAbR) lung radiotherapy using CBCT-based adaptive planning system.

Yesenia Gonzalez, Justin Visak, Luke Overman, Chien-Yi Liao, Allen Yen, Tingliang Zhuang, Bin Cai, Andrew Godley, Yuanyuan Zhang, Robert Timmerman and 4 more

Abstract read
In one paragraph

Article in Journal of applied clinical medical physics, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Yesenia GonzalezDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Justin VisakDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Luke OvermanDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Chien-Yi LiaoDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Allen YenDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Tingliang ZhuangDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Bin CaiDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Andrew GodleyDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Yuanyuan ZhangDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Robert TimmermanDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Puneeth IyengarDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Kenneth WestoverDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
David ParsonsDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.ORCID https://orcid.org/0000-0002-4466-0647
Mu-Han LinDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI Nicholas D Socci · 1985 to 2026
$347.4M
NCI NIH HHS P30 CA008748
6 · The paper itself

Abstract

purposeOnline adaptive radiotherapy relies on a high degree of automation to enable rapid planning procedures. The Varian Ethos intelligent optimization engine (IOE) was originally designed for conventional treatments so it is crucial to provide clear guidance for lung SAbR plans. This study investigates using the Ethos IOE together with adaptive-specific optimization tuning structures we designed and templated within Ethos to mitigate inter-planner variability in meeting RTOG metrics for both online-adaptive and offline SAbR plans.

methodsWe developed a planning strategy to automate the generation of tuning structures and optimization. This was validated by retrospective analysis of 35 lung SAbR cases (total 105 fractions) treated on Ethos. The effectiveness of our planning strategy was evaluated by comparing plan quality with-and-without auto-generated tuning structures. Internal target volume (ITV) contour was compared between that drawn from CT simulation and from cone-beam CT (CBCT) at time of treatment to verify CBCT image quality and treatment effectiveness. Planning strategy robustness for lung SAbR was quantified by frequency of plans meeting reference plan RTOG constraints.

resultsOur planning strategy creates a gradient within the ITV with maximum dose in the core and improves intermediate dose conformality on average by 2%. ITV size showed no significant difference between those contoured from CT simulation and first fraction, and also trended towards decreasing over course of treatment. Compared to non-adaptive plans, adaptive plans better meet reference plan goals (37% vs. 100% PTV coverage compliance, for scheduled and adapted plans) while improving plan quality (improved GI (gradient index) by 3.8%, CI (conformity index) by 1.7%).

conclusionWe developed a robust and readily shareable planning strategy for the treatment of adaptive lung SAbR on the Ethos system. We validated that automatic online plan re-optimization along with the formulated adaptive tuning structures can ensure consistent plan quality. With the proposed planning strategy, highly ablative treatments are feasible on Ethos.

Indexed as

Cone-Beam Computed TomographyLung NeoplasmsOrgans at RiskRadiosurgeryRadiotherapy DosageRadiotherapy, Intensity-ModulatedRadiotherapy Planning, Computer-AssistedAlgorithmsHumansImage Processing, Computer-AssistedRetrospective Studiesadaptive radiotherapylung SAbRtreatment‐planning

Identifiers

PMID38712917
PMCPMC11302803

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.