ESTRO 2020 Abstract Book

S50 ESTRO 2020

Material and Methods The STRIDeR project employs the scripting capabilities in RayStation (RaySearch Laboratories, Stockholm, Sweden) to create a clinically viable reRT planning pathway. The original dose distribution was deformably registered to the reRT dataset with dose mapping, per-voxel summation, and fraction size correction. This allowed optimisation of the reRT plan using the original dose distribution as anatomically appropriate background dose, transformed to the reRT fraction schedule. Normal tissue repair was incorporated as an option, as well as evaluation of cumulative EQD2 doses. Data from a cohort of 21 patients who previously received radical pelvic radiotherapy and later received 5-fraction pelvic Stereotactic Ablative Radiotherapy reRT were used to evaluate the STRIDeR tool. For the purposes of the evaluation, the aim was to achieve 95% coverage of the PTV (D95%) with the prescription dose (PD). Organ at risk (OAR) constraints could be relaxed, or increasing degrees of OAR repair included, in a stepwise manner to achieve coverage. Steps 1a-1c used a PD of 30Gy, with each step permitting increasing constraint relaxation/ OAR repair. Steps 2a-c used 25Gy, with the same constraints. Results The STRIDeR planning tool was successfully implemented in RayStation and employed in all 21 test cases. Clinically acceptable plans were produced in 18/21 cases (Figure 1). 30Gy coverage and optimal constraints (Step 1a) were achieved in 7/21 cases. 30Gy PD was maintained with relaxed constraints (Step 1b) in 10/21 cases, while in one case PD had to be reduced to 25Gy with relaxed constraints (Step 2b). Median PTV D95% was: 30.8Gy (range: 25.5- 31.8Gy). In three cases, despite the planning pathway working, clinically acceptable plans could not be achieved while respecting OAR constraints. All three cases had overlap of at least one OAR with the reRT PTV, with very limited OAR tolerance remaining after the original radiotherapy course. This was not fully appreciated during clinical reRT delivery.

and PTV int coverages were slightly improved for the external ones. Moreover, a significant improvement in PTVs and OVERLAP (between rectum and PTV high ) homogeneity were observed for both set. OARs sparing for KB-TP was slightly improved, more evidently in the external validation group. Of note, V 20Gy , V 40Gy and D max for the bladder were significantly better in KB-TP plans, V 20Gy and D mean for the bowel, as well as for V 68Gy and D max of the rectum. The automatic KB-based technique was successfully implemented in the clinical routine with a consequent large reduction of the planning time and better plan homogeneity, hopefully avoiding any risk of sub-optimal plans.

Conclusion We demonstrated the feasibility of the clinical implementation of the KB-approach to treatments delivered with HTT. For the first time to our knowledge, fully automatic planning workflow was successfully implemented for HTT planning optimization. The KB-based planning approach was able to generate high-quality automatic HTT plans, without any intervention of the planner. OC-0104 Optimising re-irradiation using anatomically appropriate, fraction size corrected background dose L. Murray 1,2 , M. Aldred 3 , S. Gregory 3 , M. Nix 3 , L. Aspin 3 , J. Lilley 3 , S. Svensson 4 , J. Uzan 5 , B. Al-Qaisieh 3 , A. Appelt 1,3 1 Leeds Institute of Medical Research- University of Leeds, Radiotherapy Research Group, Leeds, United Kingdom ; 2 Leeds Cancer Centre, Department of Clinical Oncology, Leeds, United Kingdom ; 3 Leeds Cancer Centre, Department of Medical Physics, Leeds, United Kingdom ; 4 RaySearch Laboratories, Research Group, Stockholm, Sweden ; 5 RaySearch Laboratories, Service Department, Stockholm, Sweden Purpose or Objective Re-irradiation (reRT) treatment planning is challenging: anatomical changes may occur between radiotherapy courses and fraction size effects should be considered in evaluating cumulative doses. The STRIDeR (Support Tool for Re-Irradiation Decisions guided by Radiobiology) project aims to integrate compensation for anatomical change, per-voxel dose summation, and fraction size correction into reRT treatment planning within a commercial treatment planning system (TPS). This will allow original radiotherapy dose distributions to be meaningfully used as background dose for reRT plan optimisation.

Conclusion The STRIDeR tool integrates anatomical change and per- voxel optimisation on fraction size corrected background dose for reRT treatment planning within a commercial TPS. Normal tissue repair can be optionally included. The pathway was successfully tested in a cohort of reRT patient cases. This provides scope for more informed reRT, improved evaluation of cumulative OAR doses and NTCP modelling.