Table 1 17 published articles of dosimetric studies of CBCT-guided ART
Disease site | Article | Number of patients | Adapted fractions evaluated | ART procedural time | Outcomes |
|---|---|---|---|---|---|
Abdominal oligometastases | Schiff et al. [31] | 8 | 40 | Average 22.59 min | 30/40 fractions had OAR constraint violation under no adaption, compared to only 2/40 under daily adaptation Improved GTV V100% and D95% in 25/40 and 20/40 fractions, respectively |
Breast | Montalvo et al. [48] | 22 | 106/110 | Average 15 min | PTV and CTV coverage improved significantly after adaption No difference in OAR coverage |
Breast (prone) | Yoon et al. [67] | 8 | 128 | – | Daily CBCT showed key dose parameters vary significantly for patients undergoing tangential prone breast RT |
Bladder | Åström et al. [33] | 16 | 297/512 | Median 13.9 min | Median 33.9% volume reduction in primary PTV volume Median 18.8% reduction in bowel bag V45Gy Median 70.7% reduction in rectum V50Gy |
Cervix | Branco et al. [34] | 15 | 75/75 | Average 16.8 min | CTV D99% for adapted plans comparable to non-adapted plans Bowel V45Gy and V40Gy decreased on average by 87.6 and 109.4 cc, respectively Bladder and rectum D50% decreased by 37.7% and 35.8%, respectively |
Cervix and Rectum | Yock et al. [45] | 28 (13 cervix, 15 rectum) | 149 (cervical) and 162 (rectal) | Average 24.4 min (cervical) and 9.2 min (rectal) | Dosimetric benefits can be achieved with CBCT-based online ART Procedural time spent on online ART is amenable to conventional appointment slots |
Rectum | 20 | 300 | Average 26 min | Target coverage were similar between adapted and non-adapted plans Normal tissue V95% reduced from 642 to 237 cc with online ART Median difference for bowel bag V15Gy was -126 cc (short course RT) and -62 cc (long course RT) Median difference for bladder V15Gy was 26% (long course RT) Median difference for bladder V95% was -8% (short course RT) | |
Head and Neck | Yoon et al. [47] | 5 | – | Average 19 min and 34 s | Adapted plan improved OAR sparing, while maintaining similar therapeutic dose to target |
Lung | Mao et al. [55] | 10 | 297 | – | Improve average target coverage and planning target volume minimum doses Reduced average upper dose constraints from online ART |
Pancreas | Schiff et al. [41] | 8 | 40 | Average 36.28 min | OAR and target dosimetry improved with online ART in 100% of fractions 39/40 fractions met all OAR constraints under daily adaptation, compared to 0/40 under no adaptation |
Pelvis (Anal, Rectal, and Prostate) | Calmels et al. [39] | 60 total (20 each) | – | Median 35–55 min | Automated treatment planning system implemented by online ART generated plans to comparable to manually generated plans |
Pelvis (bladder, rectum, anal, and prostate) | Sibolt et al. [40] | 39 (only 5 reported) | – | Average 17.6 min | Adapted plan was superior in 88% of cases 42% median primary PTV reduction in treated bladder patients and 24–30% V45Gy reduction to the bowel cavity compared to non-ART |
Prostate | Byrne et al. [38] | 18 | 182 | Average 19 min | Adaptive plan was preferred in 95% of fractions Adaptive plan met more goals than scheduled plan in 78% of fractions Significant dosimetric improvements |
Prostate | De Roover et al. [59] | 20 | – | – | Online ART resulted in increased seminal vesicle PTV coverage and reduced dose to the bladder and urethra, but increased dose to the rectum |
Prostate | Moazzezi et al. [54] | 25 | 250 | – | 96% of fractions required minor auto-segmentation edits Adaptation improved CTV D98% by 2.9% Adaptation reduced bladder and rectum V90% by 13.1% and 6.5%, respectively |
Prostate | Morgan et al. [36] | 20 | 248 | Average 10.7 min | Online adaptive radiotherapy decreased PTV margins Adapted plans achieved significant reductions in rectum V40Gy and V65Gy |
Prostate | Zwart et al. [37] | 11 | 220 | Average 11.9 min | PTV coverage increased for the adapted plan compared to the scheduled plan Adapted plans were more likely to meet Bladder and rectum V60Gy constraints |