Impact of Using Unedited CT-Based DIR-Propagated Autocontours on Online ART for Pancreatic SBRT

Alba Magallon-Baro*, Maaike T.W. Milder, Patrick V. Granton, Wilhelm den Toom, Joost J. Nuyttens, Mischa S. Hoogeman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
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Purpose: To determine the dosimetric impact of using unedited autocontours in daily plan adaptation of patients with locally advanced pancreatic cancer (LAPC) treated with stereotactic body radiotherapy using tumor tracking. Materials and Methods: The study included 98 daily CT scans of 35 LAPC patients. All scans were manually contoured (MAN), and included the PTV and main organs-at-risk (OAR): stomach, duodenum and bowel. Precision and MIM deformable image registration (DIR) methods followed by contour propagation were used to generate autocontour sets on the daily CT scans. Autocontours remained unedited, and were compared to MAN on the whole organs and at 3, 1 and 0.5 cm from the PTV. Manual and autocontoured OAR were used to generate daily plans using the VOLO™ optimizer, and were compared to non-adapted plans. Resulting planned doses were compared based on PTV coverage and OAR dose-constraints. Results: Overall, both algorithms reported a high agreement between unclipped MAN and autocontours, but showed worse results when being evaluated on the clipped structures at 1 cm and 0.5 cm from the PTV. Replanning with unedited autocontours resulted in better OAR sparing than non-adapted plans for 95% and 84% plans optimized using Precision and MIM autocontours, respectively, and obeyed OAR constraints in 64% and 56% of replans. Conclusion: For the majority of fractions, manual correction of autocontours could be avoided or be limited to the region closest to the PTV. This practice could further reduce the overall timings of adaptive radiotherapy workflows for patients with LAPC.

Original languageEnglish
Article number910792
JournalFrontiers in Oncology
Publication statusPublished - 8 Jun 2022

Bibliographical note

Funding Information:
This work was in part funded by a research grant of Accuray Inc., Sunnyvale, USA. Erasmus MC Cancer Institute also has a research collaboration with Elekta AB, Stockholm, Sweden and Varian, Paolo Alto, USA. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.

Funding Information:
The authors wish to thank Warren Kilby and Mark Foskey from Accuray research and development team, as well as Michael Duchateau from MIM Software for providing valuable insight and carefully reviewing this manuscript.

Publisher Copyright:
Copyright © 2022 Magallon-Baro, Milder, Granton, Toom, Nuyttens and Hoogeman.


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