ArticleRadiation oncology (London, England)2025
Prescription dose and optimisation strategies in MR-guided online adaptive radiotherapy for kidney tumours: a two-step planning analysis.
Article in Radiation oncology (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Comparative dosimetric evaluation of independent verification systems: ArcherQA versus AccuCheck for volumetric modulated Arc therapy plan validation.Radiation oncology (London, England) · 2026Article
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12 authors.
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Abstract
backgroundStereotactic radiotherapy (SRT) for kidney cancer, particularly when tumours are situated near critical organs-at-risk (OARs), presents significant challenges in achieving optimal dose delivery. MR-guided online adaptive radiotherapy (MRgoART) offers a promising solution by allowing real-time anatomical modification and plan reoptimisation. However, the ideal strategy for prescription dose selection and reoptimisation remains unclear.
methodsThis single-centre planning study evaluated kidney tumours located within 1 cm of gastrointestinal OARs. In Step 1, prescription doses for MRgoART were compared: the target dose (26 Gy) versus the planned dose (adjusted during pre-treatment planning to satisfy OAR constraints). In Step 2, two optimisation strategies were assessed: (1) covering 99% of the planning target volume (PTV) with the prescription dose (99%_xGy_Plan) and (2) delivering the full target dose with acceptable partial PTV coverage accepting dose heterogeneity (26Gy_x%_Plan), both respecting OAR constraints. Dose-volume parameters and blinded expert preferences were evaluated.
resultsOf 22 patients assessed, 14 patients with 18 tumours met the inclusion criteria. Among these, 36 MRgoART plans for 12 tumours were analysed in Step 1. Reoptimisation using the target dose resulted in significantly higher mean tumour doses, improved dose gradients, and PTV coverage metrics compared to reoptimisation based on the planned dose. In Step 2, 54 plans were assessed. Although the 26Gy_x%_Plan demonstrated superior mean tumour and PTV dose, it exhibited lower conformity. Radiation oncologists preferred the 26Gy_x%_Plan in 48% of cases, following 26% deemed almost equal, indicating its clinical advantage.
conclusionFor kidney tumours adjacent to gastrointestinal OARs, MRgoART planning should favour reoptimisation based on the target dose. A high-dose strategy with partial PTV coverage (26Gy_x%_Plan) was generally preferred by radiation oncologists, balancing therapeutic effectiveness with OAR protection.
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