
Background and purpose: Magnetic resonance imaging-guided radiotherapy (MRIgRT) enables precise tumour targeting through adaptive planning, which is particularly relevant for glioblastoma due to its dynamic morphology. Gadolinium-based contrast agents (GBCAs) enhance tumour visibility, but frequent use during MRIgRT raises safety concerns related to cumulative gadolinium exposure. This study investigated the feasibility of a reduced GBCA dose protocol for patients with glioblastoma undergoing MRIgRT, aiming to balance tumour conspicuity with minimisation of GBCA-related risks. Patient/material and methods: Nine patients with glioblastoma received hypo-fractionated MRI-Linac radiotherapy (10 × 3.4 Gy) with MRI performed with either full-dose, half-dose or no GBCA enhancement. Online gross tumour volume (GTV) delineation was performed by radiation oncologists, while offline GTV delineation was independently conducted by an expert neuroradiologist on GBCA-enhanced scans. Objective assessment using automatic thresholding and a structured Likert-scale evaluation were also performed. Results: During online adaptation, GTV volumes generally remained stable or increased, whereas offline expert assessments revealed a general volume reduction and systematic volume underestimation with half-dose scans (~18%). Relative delineation volume discrepancies were most pronounced in small tumours. Structured radiologist feedback reported lower confidence, tumour conspicuity and image quality in half-dose scans, particularly for small lesions. Otsu’s thresholding revealed reduced edge definition with decreasing contrast dose. No signs of GBCA retention were observed between fractions. Interpretation: Reduced-dose GBCA-protocols are feasible. Full-dose contrast is recommended at key fractions (e.g. baseline and mid-treatment) and for small tumours, with half-dose imaging reserved for selected intervals or larger tumours. This hybrid approach may balance safety and imaging precision in adaptive MRIgRT.
Male, Adult, Radiotherapy, Image-Guided/methods, Radiotherapy Planning, Brain Neoplasms/radiotherapy, Radiotherapy Dosage, Middle Aged, Gadolinium/administration & dosage, Magnetic Resonance Imaging/methods, Tumor Burden, Computer-Assisted/methods, Humans, Feasibility Studies, Female, Contrast Media/administration & dosage, Glioblastoma/radiotherapy, Aged
Male, Adult, Radiotherapy, Image-Guided/methods, Radiotherapy Planning, Brain Neoplasms/radiotherapy, Radiotherapy Dosage, Middle Aged, Gadolinium/administration & dosage, Magnetic Resonance Imaging/methods, Tumor Burden, Computer-Assisted/methods, Humans, Feasibility Studies, Female, Contrast Media/administration & dosage, Glioblastoma/radiotherapy, Aged
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