ArticleRadiation oncology (London, England)2026
CBCT based online daily adaptive treatment improves target coverage with limited benefit for OAR protection in SBRT prostate cancer.
Article in Radiation oncology (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe precise application of stereotactic body radiation therapy (SBRT) for prostate cancer is challenged by prostate motion and anatomical variations in surrounding organs such as the bladder and rectum. Online adaptive radiotherapy (oART) using cone beam computed tomography (CBCT) has been shown to improve target coverage while limiting doses to organs-at-risk (OARs).
methodsWe retrospectively analyzed data from 30 prostate cancer patients who were treated with CBCT-based oART simultaneous integrated boost SBRT in five fractions, divided into two dose groups: lower dose group (LDG) receiving 30 Gy to seminal vesicles and prostate, and 35 Gy to prostate, and higher dose group (HDG) receiving 30 Gy to the vesicles and prostate, and 37.5 Gy boost to the prostate. Target volumes and OARs were contoured and evaluated per fraction. For each fraction, SCH (Scheduled plan) and ADP (Adaptive plan) plans were generated. Eight target volumes and fifteen OAR DVH (Dose Volume Histogram) parameters were collected and analyzed. Statistical comparisons were performed between differences in target coverages and doses to OARs in SCH and ADP plans, and between the LDG and HDG groups.
resultsTarget coverages were significantly improved in ADP plans in both cohorts and across the entire cohort (p < 0.001). SCH plans often failed to achieve the goal for PTV prostate. The median differences between target volume parameters of SCH and ADP plans were consistent, the adaptive plans were always superior regardless of the prescribed dose. Significant deterioration in ADP was found across the entire cohort in 7 OAR volumes. Dose reductions in OARs due to adaptation were less consistent. Significant differences were observed in bladder, rectum, sigmoid, femur, and penile bulb parameters in the sub-group analysis. The LDG-ADP plans resulted in slightly higher values of rectum
conclusionsCBCT-based online adaptive SBRT for prostate cancer significantly improves target coverage compared to the scheduled plans. Although the benefits of OARs dose vary, adaptive planning offers significant dosimetric advantages, especially at higher prescribed doses. These findings support the integration of oART into prostate SBRT to optimize the treatment's efficacy and safety.
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