Purpose: This study aimed to describe the feasibility of the online adaptive radiation therapy (oART) method developed at the Hospital Quirónsalud Barcelona for prostate cancer, using a standard C-arm linear accelerator (linac) and without the support of artificial intelligence.
Methods And Materials: The first 18 patients treated at the Hospital Quirónsalud Barcelona with the developed oART method were included. An ultrahypofractionated radiation therapy scheme consisting of 7 × 6.1 Gy was used. Patients were treated on 2 conventional Varian C-arm linacs. For each patient, a reference plan based on a planning computed tomography (pCT) scan was generated using the Eclipse system. On each treatment session, the pCT scan was rigidly registered with the daily cone beam computed tomography (CT) scan. The pCT-based target (prostate) and organs at risk were mapped onto the cone beam CT images and manually adapted to take into account the anatomy of the day. The reference plan was then copied to the cone beam CT scan, and a full reoptimization was done for the current anatomy (adapted plan). For each treatment session, the unaltered reference plan was recomputed on the daily cone beam CT scan by mimicking the soft-tissue alignment performed per our standard procedure (nonadapted plan). Over the 126 adapted sessions from the 18 patients, a dosimetric comparison of adapted against nonadapted plans was done.
Results: A significant difference in the target coverage was found between the adapted and nonadapted plans (97.1 vs 90.4; P < .001) in favor of adapting. Without online adaptation, the optimal coverage of the prostate was not attained in 35% of fractions. Adapting allows for the improvement of the target coverage with compliance of all organ-at-risk dose constraints in all treatment fractions.
Conclusions: The oART technique described in this study is technically feasible with a C-arm linac. To our knowledge, this is the first clinical experience with oART for prostate cancer including full replanning and delivered with a C-arm linac without artificial intelligence capability.
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