Forecasting patient-specific dosimetric benefit from daily online adaptive radiotherapy for cervical cancer

Objective. Adaptive Radiotherapy (ART) is an emerging technique for treating cancer patients which facilitates higher delivery accuracy and has the potential to reduce toxicity. However, ART is also resource-intensive, Requiring extra human and machine time compared to standard treatment methods. In this analysis, we sought to predict the subset of node-negative cervical cancer patients with the greatest benefit from ART, so resources might be properly allocated to the highest-yield patients. Approach. CT images, initial plan data, and on-treatment Cone-Beam CT (CBCT) images for 20 retrospective cervical cancer patients were used to simulate doses from daily non-adaptive and adaptive techniques. We evaluated the coefficient of determination (R-2) between dose and volume metrics from initial treatment plans and the dosimetric benefits to the BowelV40Gy, BowelV45Gy, BladderDmean, RectumDmean BowelV40Gy. BowelV40Gy. Main results. Patients with higher initial bowel doses were correlated with the largest decreases in Bowel V40Gy 2 = 0.77 for a 3 mm PTV margin and R-2 = 0.8 for a 5 mm PTV margin). Other metrics had intermediate or no correlation. Selected covariates for the multivariate model were differences in the initial BowelV40Gy BladderDmean BowelV40Gy Significance. The resulting models could be used to prospectively triage cervical cancer patients on or off daily adaptation to optimally manage clinical resources. Additionally, this work presents a critical foundation for predicting benefits from daily adaptation that can be extended to other patient cohorts.