The first patients treated with MR-CBCT soft-tissue matching in a MR-only prostate radiotherapy pathway |
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| Affiliation: | 1. Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK;2. Translational and Clinical Research Institute, Newcastle University, Newcastle, UK;1. Servicio de Radiodiagnóstico, Hospital Universitario de Cabueñes, Gijón, Asturias, España;2. Servicio de Cirugía Cardiaca, Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, España;3. Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, Asturias, España;1. Discipline of Medical Imaging & Radiation Therapy, University College Cork, Ireland;2. Division of Midwifery & Radiography, City, University of London, UK;3. Medical Imaging Department, Corfu General Hospital, Greece, Felix Lames 6A, 1st Parodos, Corfu, Greece;4. Department of Clinical Radiology, Ioannina University Hospital, Ioannina, Greece;5. Metaxa Anticancer Hospital, Athens, Greece;6. School of Science, European University Cyprus, Nicosia, Cyprus;7. School of Mathematical Sciences, Computer Science and Engineering, City, University of London, UK;8. Section of Radiography and Radiotherapy, Dept of Biomedical Sciences, School of Health Sciences, University of West Attica, Athens, Greece;1. Calderdale and Huddersfield NHS Foundation Trust, Calderdale Royal Hospital, Salterhebble, Halifax, HX3 0PW, UK;2. Department of Diagnostic Radiography, School of Health Sciences, University of Liverpool, Johnston Building, Brownlow Hill, L69 3GB, UK;1. University of Namibia, Faculty of Health Sciences and Veterinary Medicine, School of Allied Health Sciences, Department of Radiography, P.O Box 13301, Windhoek, Namibia;1. Royal Free London NHS Foundation Trust, London, UK;2. The Royal Marsden NHS Foundation Trust, London, UK;3. Institute of Cancer Research, London, UK;4. Princess Alexandra Hospital, Raymond Terrace, Brisbane, QLD, Australia;5. University of Queensland, Brisbane, QLD, Australia |
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| Abstract: | IntroductionMagnetic Resonance (MR)-only radiotherapy for prostate cancer has previously been reported using fiducial markers for on-treatment verification. MR-Cone Beam Computed Tomography (CBCT) soft-tissue matching does not require invasive fiducial markers and enables MR-only treatments to other pelvic cancers. This study evaluated the first clinical implementation of MR-only prostate radiotherapy using MR-CBCT soft-tissue matching.MethodsTwenty prostate patients were treated with MR-only radiotherapy using a synthetic (s)CT-optimised plan with MR-CBCT soft-tissue matching. Two MR sequences were acquired: small Field Of View (FOV) for target delineation and large FOV for organs at risk delineation, sCT generation and on-treatment verification. Patients also received a CT for validation. The prostate was independently contoured on the small FOV MR, copied to the registered CT and modified if there were MR-CT soft-tissue alignment differences (MR-CT volume). This was compared to the MR-only volume with a paired t-test. The treatment plan was recalculated on CT and the doses compared. Independent offline CT-CBCT matches for 5/20 fractions were performed by three therapeutic radiographers using the MR-only contours and compared to the online MR-CBCT matches using two one-sided paired t-tests for equivalence within ±1 mm.ResultsThe MR-only volumes were significantly smaller than MR-CT (p = 0.003), with a volume ratio 0.92 ± 0.02 (mean ± standard error). The sCT isocentre dose difference to CT was 0.2 ± 0.1%. MR-CBCT soft-tissue matching was equivalent to CT-CBCT (p < 0.001), with differences of 0.1 ± 0.2 mm (vertical), ?0.1 ± 0.2 mm (longitudinal) and 0.0 ± 0.1 mm (lateral).ConclusionsMR-only radiotherapy with soft-tissue matching has been successfully clinically implemented. It produced significantly smaller target volumes with high dosimetric and on-treatment matching accuracy.Implications for practiceMR-only prostate radiotherapy can be safely delivered without using invasive fiducial markers. This enables MR-only radiotherapy to be extended to other pelvic cancers where fiducial markers cannot be used. |
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| Keywords: | MR-Only radiotherapy planning Magnetic resonance imaging Radiotherapy Prostate cancer Cone beam computed tomography Image guided radiation therapy |
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