title: Online adaptive replanning method for prostate radiotherapy.
abstract: OBJECTIVE
  To report the application of an adaptive replanning technique for prostate cancer radiotherapy (RT), consisting of two steps: (1) segment aperture morphing (SAM), and (2) segment weight optimization (SWO), to account for interfraction variations.
  
  
  METHODS
  The new "SAM+SWO" scheme was retroactively applied to the daily CT images acquired for 10 prostate cancer patients on a linear accelerator and CT-on-Rails combination during the course of RT. Doses generated by the SAM+SWO scheme based on the daily CT images were compared with doses generated after patient repositioning using the current planning target volume (PTV) margin (5 mm, 3 mm toward rectum) and a reduced margin (2 mm), along with full reoptimization scans based on the daily CT images to evaluate dosimetry benefits.
  
  
  RESULTS
  For all cases studied, the online replanning method provided significantly better target coverage when compared with repositioning with reduced PTV (13% increase in minimum prostate dose) and improved organ sparing when compared with repositioning with regular PTV (13% decrease in the generalized equivalent uniform dose of rectum). The time required to complete the online replanning process was 6 +/- 2 minutes.
  
  
  CONCLUSIONS
  The proposed online replanning method can be used to account for interfraction variations for prostate RT with a practically acceptable time frame (5-10 min) and with significant dosimetric benefits. On the basis of this study, the developed online replanning scheme is being implemented in the clinic for prostate RT.
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA. eahunbay@mcw.edu
authors.forename: Ergun E
authors.initials: EE
authors.lastname: Ahunbay
authors.forename: Cheng
authors.initials: C
authors.lastname: Peng
authors.forename: Shannon
authors.initials: S
authors.lastname: Holmes
authors.forename: Andrew
authors.initials: A
authors.lastname: Godley
authors.forename: Colleen
authors.initials: C
authors.lastname: Lawton
authors.forename: X Allen
authors.initials: XA
authors.lastname: Li
mesh_terms: D000465:Algorithms; D019583:Dose Fractionation, Radiation; D005270:Femur Head / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D009068:Movement; D011467:Prostate / Q000000981:diagnostic imaging; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D011630:Pubic Bone / Q000000981:diagnostic imaging; D011832:Radiation Injuries / Q000517:prevention & control; D011859:Radiography; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods* / Q000592:standards; D011881:Radiotherapy, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation / Q000379:methods*; D012007:Rectum / Q000000981:diagnostic imaging / Q000528:radiation effects; D013997:Time Factors; D001743:Urinary Bladder / Q000000981:diagnostic imaging