| Ma Chenying,Guo Jian,Jiang Hua,Li Zhibin,Wang Shimei,Li Binghuan,Jia Lecheng,Cao Ran,Zhang Wei,Xu Xiaoting,Zhou Juying.Clinical practice of fan beam CT-guided online adaptive radiotherapy for cervical cancer[J].Chinese Journal of Radiological Medicine and Protection,2024,44(4):262-271 |
| Clinical practice of fan beam CT-guided online adaptive radiotherapy for cervical cancer |
| Received:November 28, 2023 |
| DOI：10.3760/cma.j.cn112271-20231128-00190 |
| KeyWords:Cervical cancer Online adaptive radiotherapy Fan beam CT Artificial intelligence Image-guided radiotherapy |
| FundProject:国家自然科学基金(81602792);江苏省高等学校基础科学(自然科学)研究面上项目(23KJB310023);江苏省妇幼保健科研项目(F202210);江苏省医学重点学科(ZDXK202235);放射医学与辐射防护国家重点实验室资助项目(GZK1202101);苏州市科技项目(SLT201920);苏州市科技发展计划项目(KJXW2020008);苏州大学附属第一医院自然科学基金博习培育计划项目(BXQN202107);中关村精准医学基金会医健公益行项目(XS-ZGC-0012) |
| Author Name | Affiliation | E-mail | | Ma Chenying | Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou 215006, China | | | Guo Jian | Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou 215006, China | | | Jiang Hua | Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou 215006, China | | | Li Zhibin | Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou 215006, China | | | Wang Shimei | Shanghai United Imaging Healthcare Co., Ltd., Shanghai 200232, China | | | Li Binghuan | Shanghai United Imaging Healthcare Co., Ltd., Shanghai 200232, China | | | Jia Lecheng | Shenzhen United Imaging Research Institute of Innovative Medical Equipment, Shenzhen 518125, China | | | Cao Ran | Shanghai United Imaging Healthcare Co., Ltd., Shanghai 200232, China | | | Zhang Wei | Shanghai United Imaging Healthcare Co., Ltd., Shanghai 200232, China | | | Xu Xiaoting | Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou 215006, China | | | Zhou Juying | Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou 215006, China | zhoujuyingsy@163.com |
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| Abstract:: |
| Objective To explore the feasibility and safety of artificial intelligence (AI )- assisted, low-dose fan beam CT (FBCT)-guided online adaptive radiotherapy (OART) for cervical cancer. Method A total of 11 cervical cancer patients (10 treated with postoperative adjuvant therapy, and 1 with radical radiotherapy) underwent OART led by senior radiation oncologists (RO) on a uCT-ART platform. The feasibility of AI-assisted, low-dose FBCT-guided OART in the treatment of cervical cancer was analyzed, including the assessment of automatic contouring quality, automatic radiotherapy planning, OART online dosimetry analysis, and OART durations, as well as the analysis of radiotherapy-associated adverse reactions in the 11 cervical cancer patients. Results According to the senior ROs, OART was initiated 81 times in 297 fractions, with an average of 7.4. The average total OART duration was 18.97 min, and the average OART adjustment duration was 15.87 min. The regions of interest (ROIs) of 11 patients were automatically segmented based on CT images for positioning using the AI-assisted contouring tool. Then, the obtained ROIautowere modified and audited by ROs, yielding ROIedit. The dice similarity coefficient of the clinical target volumes (CTVs) was 0.85 ± 0.04, which was not inferior to that derived from previous models (0.89 ± 0.02; P > 0.05). The 95% Hausdorff distance was (5.64 ± 1.60) mm, which was better than that constructed using previous models [(6.28 ± 2.31) mm; t = -2.34, P < 0.05]. After the initiation of OART, a contouring strategy involving CTV rigid copy/automatic segmentation of organs at risk (OARs) + RO modification was preferred. In the OART plans, doses to the planning target volumes (PTVs) were more compact and closer to the prescribed doses overall. The dose control of OARs in the OART plans was more consistent with the clinical requirements, with the radiation doses to OARs significantly lower than those of image-guided radiation therapy plans. The conformity index and homogeneity index of the OART plans exhibited superiority over those of manual plans. In the course of OART, the target volumes between fractions fluctuated within ±5%, while the OAR volumes changed greatly without following evident laws. Regarding adverse reactions, the acute adverse reactions in the digestive, urinary, and hematopoietic systems were all of grades 1 to 2 according to the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events, with no adverse reactions of grades 3 or above occurring. Conclusions This study presents the successful implementation of the uCT-ART-based OART system in radiotherapy for cervical cancer, confirming the feasibility and safety of the clinical applications of OART. |
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