ArticleActa oncologica (Stockholm, Sweden)2025
Simulation-free cone beam CT-based online adaptive radiotherapy for metastatic spinal cord compression.
Article in Acta oncologica (Stockholm, Sweden), 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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Who cites it
1 citing paper in PubMed.
- Online adaptive radiotherapy: International strategies for AI-enabled workflow efficiency and radiation therapist-led delivery for sustainable practice.Technical innovations & patient support in radiation oncology · 2026Article
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7 authors.
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Abstract
background and purposeA simulation-free approach, using the patient's diagnostic computed tomography (CT) for treatment planning, eliminates the need for a separate planning CT. Combined with conebeam computed tomography (CBCT)-guided online adaptive radiotherapy (oART), this strategy has the potential to create a more efficient treatment workflow and reduce the burden for the patients. The study aimed to evaluate the feasibility and time consumption of different simulation-free oART workflows for patients with metastatic spinal cord compression (MSCC) to identify the most suitable option for clinical implementation. Patient/material and methods: Diagnostic CT scans from patients diagnosed with MSCC were used for treatment planning, while CBCT scans from their first treatment session were retrospectively used to emulate the treatments. Four adaptive workflows were defined and assessed: Deformable Supervised (DefSup), Deformable Unsupervised (DefUn), Rigid Supervised (RigSup), and Rigid Unsupervised (RigUn). The supervised workflows involved manual corrections to the target structures, whereas the unsupervised workflows did not include any manual adjustments. Time stamps, segmentation quality, and dose plans were used to evaluate the feasibility of each workflow.
resultsA total of 120 simulation-free emulations were performed (based on 27 patients with 30 target sites). The DefSup workflow yielded the highest accuracy in both segmentation and dose distribution. Additionally, with a median time consumption of 6.57 min, this workflow demonstrates a level of reliability and quality suitable for clinical application.
interpretationThe DefSup workflow was found to be the most optimal and safe for clinical implementation, as demonstrated by the successful treatment of the first patient with MSCC using this approach.
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