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    Feasibility of using a dual isocentre technique for treating cervical cancer on the 1.5T MR-Linac

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    Authors
    Chuter, Robert
    Brewster, Frank
    Retout, Louise
    Cree, Anthea
    Aktürk, N.
    Hales, Rosie
    Benson, Rebecca
    Hoskin, Peter J
    McWilliam, Alan
    Affiliation
    Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, Manchester, M20 4B
    Issue Date
    2022
    
    Metadata
    Show full item record
    Abstract
    Objective.Patients treated for cervical cancer exhibit large inter and intra-fraction anatomical changes. The Unity MR-Linac (MRL) can image these patients with MR prior to and during treatment which enables daily plan adaptation. However, the MRL has a limited treatment field in the sup/inf direction of 22 cm which can restrict the treatment of patients who require longer treatment fields. Here we explore potential adaptive workflows in combination with a dual isocentre approach, to widen the range of cervix patients that can benefit from this treatment.Approach.Ten cervical cancer patients were retrospectively planned with a dual isocentre technique to deliver 45 Gy in 25 fractions. 5 node-negative and 5 node-positive patients were planned using the EMBRACE II protocol. A 2 cm overlap region between the two isocentres was positioned entirely in the nodal region. A treatment workflow was simulated to account for inter-fraction anatomical change. Isocentre shifts of 3 and 6 mm were applied to investigate the effect of intra-fraction motion.Main results.Dual isocentre adapted plans ensured significantly better coverage than non-adapted (recalculated) plans with a larger benefit seen for the node-negative cases. The difference to the reference plan for the V4275 cGy to the ITV was -0.8 cGy and -8.2 cGy for the adapted and recalculated plans respectively. Movements superiorly did not affect the coverage of the ITV by more than 1%, but shifting it inferiorly caused the ITV coverage on the plan to reduce by ∼2.4% per mm.Significance.A dual isocentre technique for cervical cancer treatments and adaptive workflows have been demonstrated to recover the required plan quality for inter-fraction changes. This illustrates the feasibility of a dual isocentre technique for the MRL.
    Citation
    Chuter RW, Brewster F, Retout L, Cree A, Aktürk N, Hales R, et al. Feasibility of using a dual isocentre technique for treating cervical cancer on the 1.5T MR-Linac. Physics in medicine and biology. 2022 Dec 22. PubMed PMID: 36549006. Epub 2022/12/23. eng.
    Journal
    Physics in Medicine and Biology
    URI
    http://hdl.handle.net/10541/625926
    DOI
    10.1088/1361-6560/acae18
    PubMed ID
    36549006
    Additional Links
    https://dx.doi.org/10.1088/1361-6560/acae18
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1088/1361-6560/acae18
    Scopus Count
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