TY - JOUR
T1 - Impact of Daily Plan Adaptation on Organ-At-Risk Normal Tissue Complication Probability for Adrenal Lesions undergoing Stereotactic Ablative Radiation Therapy
T2 - NTCP advantages of adaptive MR-guided adrenal SABR
AU - Chen, Hanbo
AU - Schneiders, Famke L
AU - M E Bruynzeel, Anna
AU - Lagerwaard, Frank J
AU - van Sornsen de Koste, John R
AU - Cobussen, Paul
AU - Bohoudi, Omar
AU - Slotman, Berend J
AU - Louie, Alexander V
AU - Senan, Suresh
AU - van Sörnsen de Koste, John R.
N1 - Funding Information: HC reports grants from International Association for the Study of Lung Cancer during the conduct of the study. AMEB reports grants from ViewRay Inc. during the conduct of the study and personal fees from ViewRay Inc. outside the submitted work. AMEB is a member of the Medical Advisory Board at ViewRay Inc. FJL reports personal fees from ViewRay Inc. outside the submitted work. OB reports personal fees from ViewRay Inc. outside the submitted work. BJS reports grants from Varian medical systems as well as grants and personal fees from ViewRay Inc. outside the submitted work. AVL reports personal fees from AstraZeneca, personal fees from Varian Medical Systems and personal fees from RefleXion outside the submitted work. SS reports grants from ViewRay Inc. during the conduct of the study, grants from Varian Medical Systems, grants and personal fees from AstraZeneca, personal fees from MSD, personal fees from Celgene, personal fees from BeiGene and non-financial support from BMS outside the submitted work. FLS, JRVSDK and PC have no conflict of interest to disclose. Funding Information: This study was supported by an International Association for the Study of Lung Cancer Fellowship grant (HC). The funding source had no influence on the study process from inception to publication. Publisher Copyright: © 2021 The Author(s) Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Introduction: Stereotactic ablative radiotherapy (SABR) can achieve good local control for metastatic adrenal lesions. Magnetic resonance (MR)-guidance with daily on-table plan adaptation can augment the delivery of SABR with greater dose certainty. The goal of this study was to quantify the potential clinical benefit MR-guided daily-adaptive adrenal SABR using the normal tissue complication probability (NTCP) framework. Methods: Patients treated with adrenal MR-guided SABR at a single institution were retrospectively reviewed. Lyman-Kutcher-Burman NTCP models were used to calculate the NTCP of upper abdominal organs-at-risk (OARs) at simulation and both before and after daily on-table plan adaptation. Differences in OAR NTCPs were assessed using signed-rank tests. Potential predictors of the benefits of adaptation were assessed by linear regression. Results: Fifty-two adrenal MR-guided SABR courses were analyzed. The baseline simulation plan underestimated the absolute stomach NTCP by 10.0% on average (95% confidence interval: 4.7–15.2%, p < 0.001). Daily on-table adaptation lowered absolute NTCP by 8.7% (4.2–13.2%, p < 0.001). The most significant predictor of the benefits of adaptation was lesion laterality (p = 0.018), with left-sided lesions benefitting more (13.3% [6.3–20.4%], p < 0.001) than right-sided lesions (2.1% [−1.6–5.7%], p = 0.25). Sensitivity analyses did not change the statistical significance of the findings. Conclusion: NTCP analysis revealed that patients with left adrenal tumors were more likely to benefit from MR-guided daily on-table adaptive SABR using current dose/fractionation regimens due to reductions in predicted gastric toxicity. Right-sided adrenal lesions may be considered for dose escalation due to low predicted NTCP.
AB - Introduction: Stereotactic ablative radiotherapy (SABR) can achieve good local control for metastatic adrenal lesions. Magnetic resonance (MR)-guidance with daily on-table plan adaptation can augment the delivery of SABR with greater dose certainty. The goal of this study was to quantify the potential clinical benefit MR-guided daily-adaptive adrenal SABR using the normal tissue complication probability (NTCP) framework. Methods: Patients treated with adrenal MR-guided SABR at a single institution were retrospectively reviewed. Lyman-Kutcher-Burman NTCP models were used to calculate the NTCP of upper abdominal organs-at-risk (OARs) at simulation and both before and after daily on-table plan adaptation. Differences in OAR NTCPs were assessed using signed-rank tests. Potential predictors of the benefits of adaptation were assessed by linear regression. Results: Fifty-two adrenal MR-guided SABR courses were analyzed. The baseline simulation plan underestimated the absolute stomach NTCP by 10.0% on average (95% confidence interval: 4.7–15.2%, p < 0.001). Daily on-table adaptation lowered absolute NTCP by 8.7% (4.2–13.2%, p < 0.001). The most significant predictor of the benefits of adaptation was lesion laterality (p = 0.018), with left-sided lesions benefitting more (13.3% [6.3–20.4%], p < 0.001) than right-sided lesions (2.1% [−1.6–5.7%], p = 0.25). Sensitivity analyses did not change the statistical significance of the findings. Conclusion: NTCP analysis revealed that patients with left adrenal tumors were more likely to benefit from MR-guided daily on-table adaptive SABR using current dose/fractionation regimens due to reductions in predicted gastric toxicity. Right-sided adrenal lesions may be considered for dose escalation due to low predicted NTCP.
KW - Adaptive radiotherapy
KW - Adrenal
KW - Magnetic resonance
KW - Normal tissue complication probability
KW - Stereotactic ablative radiotherapy
KW - Stereotactic body radiation therapy
UR - http://www.scopus.com/inward/record.url?scp=85112288377&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.radonc.2021.07.026
DO - https://doi.org/10.1016/j.radonc.2021.07.026
M3 - Article
C2 - 34343546
SN - 0167-8140
VL - 163
SP - 14
EP - 20
JO - Radiotherapy and oncology
JF - Radiotherapy and oncology
ER -