Patterns of practice for adaptive and real-time radiation therapy: part I intra-fraction motion
Distefano, G. Bertholet, J. Poulsen, P. Roggen, T. Garibaldi, C. Tilly, N. Booth, J. Oelfke, U. Heijmen, B Aznar, Marianne Camille
Distefano, G.
Bertholet, J.
Poulsen, P.
Roggen, T.
Garibaldi, C.
Tilly, N.
Booth, J.
Oelfke, U.
Heijmen, B
Aznar, Marianne Camille
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Abstract
Purpose or Objective
The patterns of practice for adaptive and real-time
radiation therapy (POP-ART RT) study aims to determine
to which extent and how these methods are used in clinical
practice and to understand the barriers to
implementation. Here we report on part I: real-time
respiratory motion management (RRMM).
Material and Methods
An institution-specific questionnaire developed during the
2nd ESTRO physics workshop was distributed worldwide.
The focus was both on current practice and wishes for
implementation. Therefore, centres not (yet) doing RRMM
were encouraged to participate.
RRMM was defined as the use of gating in free-breathing
(FB) or breath-hold (BH), or tracking if the beam is
continuously realigned with the target in real-time (via
robotic or gimbal guidance, MLC or couch tracking).
Respondents were asked if they used RRMM for selected
tumor sites, the percentage of patients treated with RRMM, eligibility criteria and the monitoring signal used to
guide gating or tracking.
Respondents were also asked if they wished 1) to change
or expand their use of RRMM for a tumor site already
treated with RRMM and 2) to implement RRMM for a new
tumor site and to rank the barriers to implementation in
order of importance.
Results
The questionnaire was filled out by 200 centres from 41
countries. 68% of respondents used RRMM in at least one
tumor site (“users”). Inspiration BH was the dominant
technique for breast and lymphoma, whereas the spread
in technique was greater for other sites (Table 1).
Within any given tumor site, users only applied RRMM in a
subset of patients. The most frequently selected
percentage range of patients treated using RRMM was <25%
for lung, pancreas and lymphoma, 25-50% for breast
and >75% for liver. However, for liver and pancreas, >50%
of users applied RRMM in >50% of patients.
The main selection criteria was “left breast” (76%) for
breast and SBRT (~50%) for lung, liver and pancreas.
Across all tumor sites, external marker was the main RRMM
signal used by >60% of respondents. For breast and
lymphoma this was followed by surface imaging and
breathing volume. KV/MV imaging was frequently used for
liver and pancreas (with markers) and for lung (with or
without markers) (Fig 1a). Tracking was mainly done on
robotic linacs with hybrid monitoring.
For breast and lung, 36% and 49% of the centres
respectively wish to expand or implement RRMM (Fig 1b).
In contrast, for liver and pancreas >55% of centres do not
use RRMM and do not wish to implement it. Overall 71% of
centres wish to implement RRMM for any new treatment
site (Fig 1c) but human/financial resources and capacity
on machine were the main barriers Conclusion
Thirty-two percent of respondents do not use any form of
RRMM. Although RRMM was common in the thorax, it was
generally applied for less than half of the patients. There
is an unmet need for RRMM solutions, particularly in lung
cancer. The main barriers to implement RRMM are
human/financial resources and capacity on the machine.
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Distefano G, Bertholet J, Poulsen P, Roggen T, Garibaldi C, Tilly N, et al. OC-0703: Patterns of practice for adaptive and realtime radiation therapy: part I intra-fraction motion. Radiotherapy and Oncology . 2020 Nov;152:S394–5.