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This is a single-center, prospective pilot study evaluating the utility of HyperSight CBCT imaging and Ethos adaptive radiation planning in pediatric patients receiving radiation therapy for non-cranial tumors.
Twenty patients aged 18 or under will be enrolled. Participants will receive standard-of-care radiation therapy, with the addition of twice-weekly HyperSight CBCT scans. These scans will be used to assess anatomical changes and generate adapted radiation plans using the Ethos platform. Radiation oncologists and radiation therapists will independently evaluate the need for adaptation, and adapted vs. scheduled plans will be compared using dosimetric and anatomical similarity metrics.
An optional sub-study will allow anonymized imaging and planning data to be shared with Varian Medical Systems. The study duration will match the patient's treatment course, typically 1-6 weeks, with no additional follow-up beyond standard care.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Imaging | Other | Participants will receive standard-of-care radiation therapy, with the addition of twice-weekly HyperSight CBCT scans. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| HyperSight CBCT scans | Device | During the standard of care pediatric radiation treatment, a Cone Beam Computed Tomography (CBCT) image is taken after the patient is positioned on the radiation treatment table. This image, captured using equipment built into the treatment machine, helps ensure accurate alignment and allows assessment of tumor or tissue changes. |
| Measure | Description | Time Frame |
|---|---|---|
| Dice Similarity Coefficient | Change in Tumor and OAR Anatomy During Pediatric Radiation Therapy Using HyperSight CBCT and Ethos Adaptive Replanning. This outcome measures how tumor and organ-at-risk (OAR) anatomy changes during pediatric radiation therapy using HyperSight CBCT. | From baseline (start of radiation treatment) to end of treatment, approximately 6 to 8 weeks. |
| Hausdorff distance | Change in Tumor and OAR Anatomy During Pediatric Radiation Therapy Using HyperSight CBCT and Ethos Adaptive Replanning. This outcome measures how tumor and organ-at-risk (OAR) anatomy changes during pediatric radiation therapy using HyperSight CBCT. This will be measured in mm. | From baseline (start of radiation treatment) to end of treatment, approximately 6 to 8 weeks. |
| Volume differences | Change in Tumor and OAR Anatomy During Pediatric Radiation Therapy Using HyperSight CBCT and Ethos Adaptive Replanning. This outcome measures how tumor and organ-at-risk (OAR) anatomy changes during pediatric radiation therapy using HyperSight CBCT. This will be measured in cm^3. | Time Frame: From baseline (start of radiation treatment) to end of treatment, approximately 6 to 8 weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| Quality of cone beam CT | Using the 5 liker scale | From baseline to end of treatment (approximately 6 to 8 weeks) |
| Organ motion | Does the dose to the organ that day violate the prespecified constraints |
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Inclusion Criteria:
Exclusion Criteria:
- Patients with primary cranial tumours will be excluded due to the low expected utility of non-contrast CT scans in the delineation of brain edema and brain substructures.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Dana Keilty, MD | Contact | 416-946-4501 | 6513 | dana.keilty@uhn.ca |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Princess Margaret Cancer Centre | Recruiting | Toronto | Ontario | M5G 2M9 | Canada |
To be discussed with PI
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| ID | Term |
|---|---|
| D009369 | Neoplasms |
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| From baseline to end of treatment (approximately 6 to 8 weeks) |
| Feasibility of Conformal Planning in Traditionally Field-Based Diseases | All target coverage goals achieved with conformal planning measured in percentage (%). | From baseline to end of treatment (approximately 6 to 8 weeks) |
| Feasibility of Conformal Planning in Traditionally Field-Based Diseases | All target coverage goals achieved with conformal planning measured in volume (mm^3) | From baseline to end of treatment (approximately 6 to 8 weeks) |
| Feasibility of Conformal Planning in Traditionally Field-Based Diseases | All target coverage goals achieved with conformal planning measured in dose (gy) | From baseline to end of treatment (approximately 6 to 8 weeks) |
| Dosimetric Impact of Adaptive Radiation Therapy | Measures the differences in accumulated radiation dose to the tumor and organs at risk (OARs) between adapted and non-adapted treatment plans using dose-volume metrics. | From baseline to end of treatment (approximately 6 to 8 weeks) |
| Safety of Minimized Target Expansion Volumes | Evaluates whether reducing target margins in adaptive planning maintains safe dose coverage while avoiding increased exposure to surrounding healthy tissue. All target coverage goals achieved with smaller PTV sizes. It's a pre-defined metric that is specific to the tumour type. A common example is the dose to 95% of the PTV should be >95% of the prescription dose. | From baseline to end of treatment (approximately 6 to 8 weeks) |
| Integration of Radiation Therapy Proficiencies in Adaptive Planning | Image review, contour adjustments, and plan selection during daily treatment sessions. Measured >=0.70 Dice Similarity Coefficient between radiation oncology and radiation therapy delineations. | From baseline to end of treatment (approximately 6 to 8 weeks) |