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Aims <p>Recent advances in Radiotherapy have led to the development of online adaptive RT (oART), a procedure addressing inter-fraction anatomical variations. Integrating artificial intelligence (AI) into the oART procedure speeds up the process and reduces user dependency. This study investigates the dosimetric advantage of implementing AI-driven oART in prostate cancer.</p> Methods <p>A total of 31 prostate cancer patients treated with oART on an AI-integrated Linac were analyzed. Patients were categorized by nodal involvement. For prostate-only cases, the Clinical Target Volume (CTV) included the prostate and seminal vesicles (CTV1), with a 5&#xa0;mm margin (8&#xa0;mm caudally) for Planning Target Volume (PTV), named PTV1. For nodal cases, pelvic lymph nodes were added (and categorized as CTV2) with a 5&#xa0;mm isotropic margin (PTV2). Daily CBCTs were acquired, with OARs (rectum, bladder, bowels) automatically segmented by the AI system, while targets were manually delineated. Two plans were generated: a predicted one, calculating the original plan’s fluence on daily anatomy, and an adapted one, with complete fluence re-optimization. Daily DVH indicators for PTV(V95%), CTV(D98%), bladder (V65Gy), bowel (V45Gy), and rectum (V50Gy) were compared between predicted and adapted plans using the Wilcoxon-Mann-Whitney test. Total session time, from CBCT acquisition to treatment completion, was also recorded.</p> Results <p>oART treatment improved prostate coverage in both patient groups (+10.4% and +11.8% in PTV V95% for patients with and without lymph nodes) and CTV D98% (+2.6% with lymph nodes, +2.9% without). Improvements for arm 2 were smaller (+3.1% in PTV2 V95%, +2.2% in CTV2 D98%). Statistical differences were insignificant in OAR DVH indicators (<i>p</i> &gt; 0.1). Median treatment time was 25&#xa0;min and 32&#xa0;min for prostate-only and lymph node cases, respectively.</p> Conclusion <p>This study demonstrates that oART in prostate cancer results in a significant improvement in target coverage with no significant difference in OARs.</p>

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AI-driven online adaptive radiotherapy in prostate cancer treatment: considerations on activity time and dosimetric benefits

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月25日

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  • Francesco Preziosi,
  • Althea Boschetti,
  • Francesco Catucci,
  • Claudio Votta,
  • Luca Vellini,
  • Sebastiano Menna,
  • Flaviovincenzo Quaranta,
  • Elisa Pilloni,
  • Andrea D’Aviero,
  • Michele Aquilano,
  • Carmela Di Dio,
  • Martina Iezzi,
  • Alessia Re,
  • Antonio Piras,
  • Marco Marras,
  • Francesca Gruosso,
  • Domenico Piro,
  • Danila Piccari,
  • Luca Tagliaferri,
  • Maria Antonietta Gambacorta,
  • Luca Indovina,
  • Gian Carlo Mattiucci,
  • Davide Cusumano

摘要

Aims

Recent advances in Radiotherapy have led to the development of online adaptive RT (oART), a procedure addressing inter-fraction anatomical variations. Integrating artificial intelligence (AI) into the oART procedure speeds up the process and reduces user dependency. This study investigates the dosimetric advantage of implementing AI-driven oART in prostate cancer.

Methods

A total of 31 prostate cancer patients treated with oART on an AI-integrated Linac were analyzed. Patients were categorized by nodal involvement. For prostate-only cases, the Clinical Target Volume (CTV) included the prostate and seminal vesicles (CTV1), with a 5 mm margin (8 mm caudally) for Planning Target Volume (PTV), named PTV1. For nodal cases, pelvic lymph nodes were added (and categorized as CTV2) with a 5 mm isotropic margin (PTV2). Daily CBCTs were acquired, with OARs (rectum, bladder, bowels) automatically segmented by the AI system, while targets were manually delineated. Two plans were generated: a predicted one, calculating the original plan’s fluence on daily anatomy, and an adapted one, with complete fluence re-optimization. Daily DVH indicators for PTV(V95%), CTV(D98%), bladder (V65Gy), bowel (V45Gy), and rectum (V50Gy) were compared between predicted and adapted plans using the Wilcoxon-Mann-Whitney test. Total session time, from CBCT acquisition to treatment completion, was also recorded.

Results

oART treatment improved prostate coverage in both patient groups (+10.4% and +11.8% in PTV V95% for patients with and without lymph nodes) and CTV D98% (+2.6% with lymph nodes, +2.9% without). Improvements for arm 2 were smaller (+3.1% in PTV2 V95%, +2.2% in CTV2 D98%). Statistical differences were insignificant in OAR DVH indicators (p > 0.1). Median treatment time was 25 min and 32 min for prostate-only and lymph node cases, respectively.

Conclusion

This study demonstrates that oART in prostate cancer results in a significant improvement in target coverage with no significant difference in OARs.