1
|
Fu W, Zhang Y, Mehta K, Chen A, Musunuru HB, Pucci P, Kubis J, Huq MS. Evaluating intra-fractional tumor motion in lung stereotactic radiotherapy with deep inspiration breath-hold. J Appl Clin Med Phys 2024; 25:e14414. [PMID: 38803045 PMCID: PMC11302799 DOI: 10.1002/acm2.14414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/19/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE To evaluate the intra-fractional tumor motion in lung stereotactic body radiotherapy (SBRT) with deep inspiration breath-hold (DIBH), and to investigate the adequacy of the current planning target volume (PTV) margins. METHODS Twenty-eight lung SBRT patients with DIBH were selected in this study. Among the lesions, twenty-three were at right or left lower lobe, two at right middle lobe, and three at right or left upper lobe. Post-treatment gated cone-beam computed tomography (CBCT) was acquired to quantify the intra-fractional tumor shift at each treatment. These obtained shifts were then used to calculate the required PTV margin, which was compared with the current applied margin of 5 mm margin in anterior-posterior (AP) and right-left (RL) directions and 8 mm in superior-inferior (SI) direction. The beam delivery time was prolonged with DIBH. The actual beam delivery time with DIBH (Tbeam_DIBH) was compared with the beam delivery time without DIBH (Tbeam_wo_DIBH) for the corresponding SBRT plan. RESULTS A total of 113 treatments were analyzed. At six treatments (5.3%), the shifts exceeded the tolerance defined by the current PTV margin. The average shifts were 0.0 ± 1.9 mm, 0.1±1.5 mm, and -0.5 ± 3.7 mm in AP, RL, and SI directions, respectively. The required PTV margins were determined to be 4.5, 3.9, and 7.4 mm in AP, RL, and SI directions, respectively. The average Tbeam_wo_DIBH and Tbeam_DIBH were 2.4 ± 0.4 min and 3.6 ± 1.5 min, respectively. The average treatment slot for lung SBRT with DIBH was 25.3 ± 7.9 min. CONCLUSION Intra-fractional tumor motion is the predominant source of treatment uncertainties in CBCT-guided lung SBRT with DIBH. The required PTV margin should be determined based on data specific to each institute, considering different techniques and populations. Our data indicate that our current applied PTV margin is adequate, and it is possible to reduce further in the RL direction. The time increase of Tbeam_DIBH, relative to the treatment slot, is not clinically significant.
Collapse
Affiliation(s)
- Weihua Fu
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Yongqian Zhang
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Kiran Mehta
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Alex Chen
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Hima Bindu Musunuru
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Pietro Pucci
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Jason Kubis
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - M. Saiful Huq
- Department of Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| |
Collapse
|
2
|
Hoffmann L, Ehmsen ML, Hansen J, Hansen R, Knap MM, Mortensen HR, Poulsen PR, Ravkilde T, Rose HK, Schmidt HH, Worm ES, Møller DS. Repeated deep-inspiration breath-hold CT scans at planning underestimate the actual motion between breath-holds at treatment for lung cancer and lymphoma patients. Radiother Oncol 2023; 188:109887. [PMID: 37659663 DOI: 10.1016/j.radonc.2023.109887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE/OBJECTIVE Deep-inspiration breath-hold (DIBH) during radiotherapy may reduce dose to the lungs and heart compared to treatment in free breathing. However, intra-fractional target shifts between several breath-holds may decrease target coverage. We compared target shifts between four DIBHs at the planning-CT session with those measured on CBCT-scans obtained pre- and post-DIBH treatments. MATERIAL/METHODS Twenty-nine lung cancer and nine lymphoma patients were treated in DIBH. An external gating block was used as surrogate for the DIBH-level with a window of 2 mm. Four DIBH CT-scans were acquired: one for planning (CTDIBH3) and three additional (CTDIBH1,2,4) to assess the intra-DIBH target shifts at scanning by registration to CTDIBH3. During treatment, pre-treatment (CBCTpre) and post-treatment (CBCTpost) scans were acquired. For each pair of CBCTpre/post, the target intra-DIBH shift was determined. For lung cancer, tumour (GTV-Tlung) and lymph nodes (GTV-Nlung) were analysed separately. Group mean (GM), systematic and random errors, and GM for the absolute maximum shifts (GMmax) were calculated for the shifts between CTDIBH1,2,3,4 and between CBCTpre/post. RESULTS For GTV-Tlung, GMmax was larger at CBCT than CT in all directions. GMmax in cranio-caudal direction was 3.3 mm (CT)and 6.1 mm (CBCT). The standard deviations of the shifts in the left-right and cranio-caudal directions were larger at CBCT than CT. For GTV-Nlung and CTVlymphoma, no difference was found in GMmax or SD. CONCLUSION Intra-DIBH shifts at planning-CT session are generally smaller than intra-DIBH shifts observed at CBCTpre/post and therefore underestimate the intra-fractional DIBH uncertainty during treatment. Lung tumours show larger intra-fractional variations than lymph nodes and lymphoma targets.
Collapse
Affiliation(s)
- Lone Hoffmann
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - M L Ehmsen
- Danish Center for Proton Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - J Hansen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - R Hansen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - M M Knap
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - H R Mortensen
- Danish Center for Proton Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - P R Poulsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Danish Center for Proton Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - T Ravkilde
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - H K Rose
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - H H Schmidt
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - E S Worm
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - D S Møller
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
3
|
Håkansson K, Josipovic M, Ottosson W, Behrens CP, Vogelius IR, Persson G. Evaluating the dosimetric effect of intra-fractional variations in deep inspiration breath-hold radiotherapy - a proof-of-concept study. Acta Oncol 2023; 62:1246-1250. [PMID: 37738385 DOI: 10.1080/0284186x.2023.2259084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023]
Affiliation(s)
- K Håkansson
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - M Josipovic
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - W Ottosson
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - C P Behrens
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Health Technology, Technical University of Denmark, Roskilde, Denmark
| | - I R Vogelius
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - G Persson
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| |
Collapse
|
4
|
Aznar MC, Carrasco de Fez P, Corradini S, Mast M, McNair H, Meattini I, Persson G, van Haaren P. ESTRO-ACROP guideline: Recommendations on implementation of breath-hold techniques in radiotherapy. Radiother Oncol 2023; 185:109734. [PMID: 37301263 DOI: 10.1016/j.radonc.2023.109734] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
The use of breath-hold techniques in radiotherapy, such as deep-inspiration breath hold, is increasing although guidelines for clinical implementation are lacking. In these recommendations, we aim to provide an overview of available technical solutions and guidance for best practice in the implementation phase. We will discuss specific challenges in different tumour sites including factors such as staff training and patient coaching, accuracy, and reproducibility. In addition, we aim to highlight the need for further research in specific patient groups. This report also reviews considerations for equipment, staff training and patient coaching, as well as image guidance for breath-hold treatments. Dedicated sections for specific indications, namely breast cancer, thoracic and abdominal tumours are also included.
Collapse
Affiliation(s)
- Marianne Camille Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom.
| | - Pablo Carrasco de Fez
- Servei de Radiofísica i Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Mirjam Mast
- Department of Radiotherapy, Haaglanden Medical Center, Leidschendam, The Netherlands
| | - Helen McNair
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, UK
| | - Icro Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Department of Clinical and Experimental Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Gitte Persson
- Department of Oncology, Herlev-Gentofte Hospital, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Denmark
| | - Paul van Haaren
- Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
| |
Collapse
|
5
|
But-Hadzic J, Strljic K, Zager Marcius V. The spine and carina as a surrogate for target registration in cone-beam CT imaging verification in locally advanced lung cancer radiotherapy. Radiol Oncol 2023; 57:86-94. [PMID: 36942905 PMCID: PMC10039477 DOI: 10.2478/raon-2022-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 10/19/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The aim of the study was to evaluate the accuracy of volumetric lung image guidance using the spine or carina as a surrogate to target for image registration, as the best approach is not established. PATIENTS AND METHODS Cone beam computed tomography images from the 1st, 10th, 15th, and 20th fraction in 40 lung cancer patients treated with radical radiotherapy were retrospectively registered to planning CT, using three approaches. The spine and carina alignment set-up deviations from a reference (tumour/lymph nodes) registration in the lateral (LAT), longitudinal (LONG) and vertical (VRT) directions were analysed and compared. Tumour location and nodal stage influence on registration accuracy were explored. RESULTS The spine and carina mean set-up deviation from reference were largest in the LONG, with the best match in the VRT and LAT, respectively. Both strategies were more accurate in central tumours, with the carina being more precise in 50% LAT and 66% LONG mean deviations. For all measurements in all patients a carina vs. spine registration comparison showed improved carina accuracy in LAT and LONG. In comparative subgroup analysis the carina was superior compared to spine in LAT and LONG in centrally located tumours, N2 and N3. Both strategies were comparable for peripheral tumours and N0. CONCLUSIONS Carina registration shows greater accuracy compared to spine in the LAT and LONG directions and is superior in central tumours, N2 and N3. The spine and carina surrogates are equally accurate for peripheral tumours and N0. We propose the carina as a surrogate to target for CBCT image registration in locally advanced lung cancer.
Collapse
Affiliation(s)
- Jasna But-Hadzic
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Karmen Strljic
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Valerija Zager Marcius
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Department of Medical Imaging and Radiotherapy, Ljubljana, Slovenia
| |
Collapse
|
6
|
Appel S, Lawrence YR, Bar J, Jacobson G, Marom EM, Katzman T, Ben-Ayun M, Dubinski S, Haisraely O, Weizman N, Davidson T, Weiss I, Mansano A, Goldstein JD, Symon Z. Deep inspiratory breath hold assisted by continuous positive airway pressure ventilation for lung stereotactic body radiotherapy. Cancer Radiother 2023; 27:23-30. [PMID: 36057519 DOI: 10.1016/j.canrad.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/14/2022] [Accepted: 05/24/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE Continuous positive airway pressure (CPAP) ventilation hyperinflates the lungs and reduces diaphragmatic motion. We hypothesized that CPAP could be safely combined with deep inspiratory breath hold (CPAP-DIBH) during lung stereotactic radiotherapy (SBRT). MATERIAL AND METHODS Patients with stage-1 lung cancer or lung metastasis treated with CPAP-DIBH SBRT between 3/2017-5/2021 were analyzed retrospectively. Patient characteristics, treatment parameters, duration of breath holds in all sessions and tolerance to CPAP-DIBH were recorded. Local control (LC) was assessed from CT or PET-CT imaging. The distances between the tumor and mediastinal organs at risk (OAR) in centrally located tumors using either free breathing (FB) or CPAP-DIBH were compared. Toxicity was graded retrospectively. RESULTS Forty-five patients with 71 lesions were treated with CPAP-DIBH SBRT. Indications for CPAP-DIBH were prior radiation (35/71, 65%), lower lobe location (34/71, 48%), multiple lesions (26/71, 36.6%) and proximity to mediastinal OAR (7/71, 10%). Patient characteristics were: F:M 43%: 57%; mean gross tumor volume 4.5cm3 (SD 7.9), mean planning target volume 20cm3 (SD 27), primary: metastatic lesions (7%:93%). Mean radiation dose was 52.5 Gray (SD3.5). Mean lung volume was 5292cm3 (SD 1106). Mean duration of CPAP-DIBH was 41.3s (IQR 31-46.8). LC at 2 years was 89.5% (95% CI 76-95.5). In patients with central lesions, the distance between the tumor and mediastinal OAR increased from 0.84cm (SD 0.65) with FB to 1.23cm (SD 0.8) with CPAP-DIBH (p=0.002). Most patients tolerated CPAP well and completed all treatments after starting therapy. Three patients did not receive treatment: 2 were unable to tolerate CPAP and 1 had syncope (pre-existing). Toxicity was grade 2 in 4/65 (6%) and grade 3 in 1/65 (1.5%). There was no grade 2 or higher esophageal or tracheal toxicities. CONCLUSION CPAP-DIBH assisted lung SBRT was tolerated well and was associated with minimal toxicity and favorable LC. This technique may be considered when treating multiple lung lesions, lesions located in the lower lobes or adjacent to mediastinal OAR.
Collapse
Affiliation(s)
- Sarit Appel
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yaacov Richard Lawrence
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jair Bar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Galia Jacobson
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edith M Marom
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Tamar Katzman
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maoz Ben-Ayun
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sergei Dubinski
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ory Haisraely
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Weizman
- Department of Radiation Oncology, Hadassah Medical Center, Jerusalem, Israel
| | - Tima Davidson
- Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Ilana Weiss
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mansano
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Zvi Symon
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
7
|
Nangia S, Khosa R, Piyushi D, Singh M, Singh G, Sreedevi K, Chauhan SK, Rout SK, Oomen S. Deep Inspiratory Breath-Hold Radiation for Left-Sided Breast Cancer using Novel Frame-based Tactile Feedback. J Med Phys 2023; 48:85-89. [PMID: 37342598 PMCID: PMC10277295 DOI: 10.4103/jmp.jmp_79_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/05/2022] [Accepted: 12/19/2022] [Indexed: 06/23/2023] Open
Abstract
A frame providing tactile feedback for the reproducibility of deep inspiratory breath-hold (DIBH) is described. The frame, fitted across the patient, comprises a horizontal bar, parallel to the patient's long axis, and holds a graduated pointer perpendicular to it. The pointer provides individualized tactile feedback for reproducibility of DIBH. Within the pointer is a movable pencil, bearing a 5 mm coloured strip which becomes visible only during DIBH, and acts as a visual cue to the therapist. The average variation in separation in the planning and pretreatment cone-beam computed tomography of 10 patients was 2 mm (confidence interval 1.95-2.05). Frame-based tactile feedback is a novel, reproducible technique for DIBH.
Collapse
Affiliation(s)
- Sapna Nangia
- Department of Radiation Oncology, Indraprastha Apollo Hospital, Chennai, Tamil Nadu, India
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - Robin Khosa
- Department of Radiation Oncology, Indraprastha Apollo Hospital, Chennai, Tamil Nadu, India
| | - Divya Piyushi
- Department of Radiation Oncology, Indraprastha Apollo Hospital, Chennai, Tamil Nadu, India
- Department of Medical Oncology, Max BLK Hospital, Chennai, Tamil Nadu, India
| | - Maneesh Singh
- Department of Radiation Oncology, Indraprastha Apollo Hospital, Chennai, Tamil Nadu, India
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Grishma Singh
- Department of Radiation Oncology, Indraprastha Apollo Hospital, Chennai, Tamil Nadu, India
- Department of Medical Oncology, Max Hospital Patparganj, Chennai, Tamil Nadu, India
| | - K. Sreedevi
- Department of Radiation Oncology, Indraprastha Apollo Hospital, Chennai, Tamil Nadu, India
| | - Sunil Kumar Chauhan
- Department of Radiation Oncology, Indraprastha Apollo Hospital, Chennai, Tamil Nadu, India
| | - Sanjay Kumar Rout
- Department of Radiation Oncology, Indraprastha Apollo Hospital, Chennai, Tamil Nadu, India
| | - Saji Oomen
- Department of Radiation Oncology, Indraprastha Apollo Hospital, Chennai, Tamil Nadu, India
| |
Collapse
|
8
|
Mørkeset ST, Lervåg C, Lund JÅ, Jensen C. Clinical experience of volumetric-modulated flattening filter free stereotactic body radiation therapy of lesions in the lung with deep inspiration breath-hold. J Appl Clin Med Phys 2022; 23:e13733. [PMID: 35867387 PMCID: PMC9512343 DOI: 10.1002/acm2.13733] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/19/2022] [Accepted: 06/23/2022] [Indexed: 11/05/2022] Open
Abstract
This clinical study aimed to evaluate lung cancer patients' ability to perform deep inspiration breath-hold (DIBH) during CT simulation and throughout the treatment course of stereotactic body radiation therapy (SBRT). In addition, target sizes, organ at risk (OAR) sizes, and doses to the respective volumes in filter-free volumetric-modulated arc therapy plans performed under free-breathing (FB) and DIBH conditions were evaluated. Twenty-one patients with peripheral lesions were included, of which 13 were eligible for SBRT. All patients underwent training for breath-hold during CT, and if they complied with the requirements, two CT scans were obtained: CT scan in DIBH and a four-dimensional CT scan in FB. The treatment plans in FB and DIBH were generated, and the dose parameters and volume sizes were compared. The endpoints for evaluation were patient compliance, target dose coverage, and doses to the OARs. This clinical study showed high patient DIBH compliance during both CT simulation and treatment for patients with lung cancer. A significant reduction in target volumes was achieved with SBRT in DIBH, in addition to significantly decreased doses to the heart, chest wall, and lungs. DIBH in SBRT of lung lesions is feasible, and a routine to manage intra-fractional deviation should be established upon implementation.
Collapse
Affiliation(s)
- Siri T Mørkeset
- Department of Oncology and Rehabilitation, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | - Christoffer Lervåg
- Department of Oncology and Rehabilitation, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | - Jo-Åsmund Lund
- Department of Oncology and Rehabilitation, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway.,Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
| | - Christer Jensen
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway.,Department of Medicine and Healthcare, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| |
Collapse
|
9
|
Prado A, Zucca D, De la Casa MÁ, Martí J, Alonso L, de Acilu PG, García J, Hernando O, Fernández-Letón P, Rubio C. Intrafraction target shift comparison using two breath-hold systems in lung stereotactic body radiotherapy. Phys Imaging Radiat Oncol 2022; 22:57-62. [PMID: 35514526 PMCID: PMC9065403 DOI: 10.1016/j.phro.2022.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 12/25/2022] Open
Abstract
Background and purpose In lung Stereotactic Body Radiotherapy (SBRT) respiratory management is used to reduce target motion due to respiration. This study aimed (1) to estimate intrafraction shifts through a Cone Beam Computed Tomography (CBCT) acquired during the first treatment arc when deep inspiration breath-hold (DIBH) was performed using spirometry-based (SB) or surface-guidance (SG) systems and (2) to analyze the obtained results depending on lesion localization. Material and methods A sample of 157 patients with 243 lesions was analyzed. A total of 860 and 410 fractions were treated using SB and SG. Averaged intrafraction shifts were estimated by the offsets obtained when registering a CBCT acquired during the first treatment arc with the planning CT. Offsets were recorded in superior-inferior (SI), left-right (LR) and anterior-posterior (AP). Significance tests were applied to account for differences in average offsets and variances between DIBH systems. Systematic and random errors were computed. Results Average offset moduli were 2.4 ± 2.2 mm and 3.5 ± 2.6 mm for SB and SG treatments (p < 0.001). When comparing SB and SG offset distributions in each direction no differences were found in average values (p > 0.3). However, variances were statistically smaller for SB than for SG (p < 0.001). The number of vector moduli offsets greater than 5 mm was 2.1 times higher for SG. Compared to other locations, lower lobe lesions moduli were at least 2.3 times higher. Conclusions Both systems were accuracy-equivalent but not precision-equivalent systems. Furthermore, the SB system was more precise than the SG one. Despite DIBH, patients with lower lobe lesions had larger offsets than superior lobe ones, mainly in SI.
Collapse
Affiliation(s)
- Alejandro Prado
- Medical Physics and Radiation Protection Department, HU HM Sanchinarro, HM Hospitales, c\ Oña n°10, 28050 Madrid, Spain
| | - Daniel Zucca
- Medical Physics and Radiation Protection Department, HU HM Sanchinarro, HM Hospitales, c\ Oña n°10, 28050 Madrid, Spain
| | - Miguel Ángel De la Casa
- Medical Physics and Radiation Protection Department, HU HM Sanchinarro, HM Hospitales, c\ Oña n°10, 28050 Madrid, Spain
| | - Jaime Martí
- Medical Physics and Radiation Protection Department, HU HM Sanchinarro, HM Hospitales, c\ Oña n°10, 28050 Madrid, Spain
| | - Leyre Alonso
- Medical Physics and Radiation Protection Department, HU HM Sanchinarro, HM Hospitales, c\ Oña n°10, 28050 Madrid, Spain
| | - Paz García de Acilu
- Medical Physics and Radiation Protection Department, HU HM Puerta del Sur, HM Hospitales, Av. Carlos V n° 70, 28938 Móstoles, Madrid, Spain
| | - Juan García
- Medical Physics and Radiation Protection Department, HU HM Puerta del Sur, HM Hospitales, Av. Carlos V n° 70, 28938 Móstoles, Madrid, Spain
| | - Ovidio Hernando
- Radiation Oncology Department, HU HM Puerta del Sur, HM Hospitales, Av. Carlos V n° 70, 28938 Móstoles, Madrid, Spain
| | - Pedro Fernández-Letón
- Medical Physics and Radiation Protection Department, HU HM Sanchinarro, HM Hospitales, c\ Oña n°10, 28050 Madrid, Spain
- Medical Physics and Radiation Protection Department, HU HM Puerta del Sur, HM Hospitales, Av. Carlos V n° 70, 28938 Móstoles, Madrid, Spain
| | - Carmen Rubio
- Radiation Oncology Department, HU HM Sanchinarro, HM Hospitales, c\ Oña n°10, 28050 Madrid, Spain
- Radiation Oncology Department, HU HM Puerta del Sur, HM Hospitales, Av. Carlos V n° 70, 28938 Móstoles, Madrid, Spain
| |
Collapse
|
10
|
Duan J, Guo R, Wei W, Zhu J, Qiu Q, Zhang R, Meng X. Demonstration of quasi-real-time intrafractional motion in esophageal cancer radiotherapy provided by ExacTrac X-ray snap verification. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:677-687. [PMID: 35527623 DOI: 10.3233/xst-221165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the following hypotheses: (1) ExacTrac X-ray Snap Verification (ET-SV) is an alternative to CBCT for positioning patients with esophageal carcinoma (EC), (2) ET-SV can detect displacement in EC patients during radiotherapy (RT) and (3) EC patients can be feasibly monitored in quasi-real-time with ET-SV during RT. METHODS Anthropomorphic phantoms and 13 patients were included in this study. CBCT and ET-SV were both implemented before treatment delivery to detect displacement, and their correction results were compared. For the patient tests, positional correction in 3 translational directions and the yaw direction were applied using the ET-SV correction results. The residual error was detected immediately using ET-SV. Finally, to acquire the intrafractional motion, ET-SV was implemented when the gantry was at 0°, 90°, 180° and 270°, respectively. RESULTS In phantom tests, the maximum value of the difference in displacement between the CBCT and ET systems was 1.16 mm for translation and 0.31° for yaw. According to Bland-Altman analysis of the patient test results, 5% (5/98), 5% (5/98), 5% (5/98), and 4% (4/98) of points were beyond the upper and lower limits of agreement in the AP, SI, LR and yaw directions, respectively. The mean residual error was -0.482 mm, 1.215 mm, 1.0 mm, -0.487°, 0.105°, and 0.003° in the AP, SI, LR, pitch, roll and yaw directions, respectively. The intrafractional displacement ranged from -0.21 mm to 0 mm for translation and from -0.63° to 0.21° for rotation. The mean total translational error for intrafractional motion increased from 0.47 mm to 1.14 mm during the treatment. CONCLUSION The accuracy of ET-SV for EC RT positional correction is comparable to that of CBCT. Thus, Quasi-real-time intrafractional monitoring can be used to detect EC patient displacement during radiotherapy.
Collapse
Affiliation(s)
- Jinghao Duan
- School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, China
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ran Guo
- Department of Radiation Oncology, Jining NO.1 People's Hospital, Jining, China
| | - Wenqiang Wei
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jian Zhu
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qingtao Qiu
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ruohui Zhang
- Department of Radiotherapy, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiangjuan Meng
- Department of Clinical Laboratory, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| |
Collapse
|
11
|
Botticella A, Levy A, Auzac G, Chabert I, Berthold C, Le Pechoux C. Tumour motion management in lung cancer: a narrative review. Transl Lung Cancer Res 2021; 10:2011-2017. [PMID: 34012810 PMCID: PMC8107759 DOI: 10.21037/tlcr-20-856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Respiratory motion is one of the geometrical uncertainties that may affect the accuracy of thoracic radiotherapy in the treatment of lung cancer. Accounting for tumour motion may allow reducing treatment volumes, irradiated healthy tissue and possibly toxicity, and finally enabling dose escalation. Historically, large population-based margins were used to encompass tumour motion. A paradigmatic change happened in the last decades led to the development of modern imaging techniques during the simulation and the delivery, such as the 4-dimensional (4D) computed tomography (CT) or the 4D-cone beam CT scan, has contributed to a better understanding of lung tumour motion and to the widespread use of individualised margins (with either an internal tumour volume approach or a mid-position/ventilation approach). Moreover, recent technological advances in the delivery of radiotherapy treatments (with a variety of commercial solution allowing tumour tracking, gating or treatments in deep-inspiration breath-hold) conjugate the necessity of minimising treatment volumes while maximizing the patient comfort with less invasive techniques. In this narrative review, we provided an introduction on the intra-fraction tumour motion (in both lung tumours and mediastinal lymph-nodes), and summarized the principal motion management strategies (in both the imaging and the treatment delivery) in thoracic radiotherapy for lung cancer, with an eye on the clinical outcomes.
Collapse
Affiliation(s)
- Angela Botticella
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, F-94805, Villejuif, France
| | - Antonin Levy
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, F-94805, Villejuif, France.,Univ Paris Sud, Université Paris-Saclay, F-94270, Le Kremlin-Bicêtre, France.,INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Guillaume Auzac
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, F-94805, Villejuif, France
| | - Isabelle Chabert
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, F-94805, Villejuif, France
| | - Céline Berthold
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, F-94805, Villejuif, France
| | - Cécile Le Pechoux
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, F-94805, Villejuif, France
| |
Collapse
|
12
|
Josipovic M, Aznar MC, Thomsen JB, Scherman J, Damkjaer SMS, Nygård L, Specht L, Pøhl M, Persson GF. Deep inspiration breath hold in locally advanced lung cancer radiotherapy: validation of intrafractional geometric uncertainties in the INHALE trial. Br J Radiol 2019; 92:20190569. [PMID: 31544478 PMCID: PMC6913352 DOI: 10.1259/bjr.20190569] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Patients with locally advanced non-small cell lung cancer (NSCLC) were included in a prospective trial for radiotherapy in deep inspiration breath hold (DIBH). We evaluated DIBH compliance and target position reproducibility. METHODS Voluntary, visually guided DIBHs were performed with optical tracking. Patients underwent three consecutive DIBH CT scans for radiotherapy planning. We evaluated the intrafractional uncertainties in the position of the peripheral tumour, lymph nodes and differential motion between them, enabling PTV margins calculation. Patients who underwent all DIBH imaging and had tumour position reproducibility <8 mm were up-front DIBH compliant. Patients who performed DIBHs throughout the treatment course were overall DIBH compliant. Clinical parameters and DIBH-related uncertainties were validated against our earlier pilot study. RESULTS 69 of 88 included patients received definitive radiotherapy. 60/69 patients (87%) were up-front DIBH compliant. DIBH plan was not superior in seven patients and three lost DIBH ability during the treatment, leaving 50/69 patients (72%) overall DIBH compliant.The systematic and random errors between consecutive DIBHs were small but differed from the pilot study findings. This led to slightly different PTV margins between the two studies. CONCLUSIONS DIBH compliance and reproducibility was high. Still, this validation study highlighted the necessity of designing PTV margins in larger, representative patient cohorts. ADVANCES IN KNOWLEDGE We demonstrated high DIBH compliance in locally advanced NSCLC patients. DIBH does not eliminate but mitigates the target position uncertainty, which needs to be accounted for in treatment margins. Margin design should be based on data from larger representative patient groups.
Collapse
Affiliation(s)
| | | | - Jakob B Thomsen
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | | | - Sidsel MS Damkjaer
- Department of Hematology and Oncology Radiation Physics, Skåne University Hospital, 21185 Lund, Sweden
| | - Lotte Nygård
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | | | - Mette Pøhl
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | | |
Collapse
|
13
|
Blessing M, Hofmann J, Vogel L, Boda-Heggemann J, Lohr F, Wenz F, Stieler F, Simeonova-Chergou A. An offline technique to evaluate residual motion of the diaphragm during deep inspiratory breath-hold from cone-beam CT datasets. Strahlenther Onkol 2018; 194:855-860. [DOI: 10.1007/s00066-018-1313-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/25/2018] [Indexed: 12/25/2022]
|
14
|
Medical physics in radiation Oncology: New challenges, needs and roles. Radiother Oncol 2017; 125:375-378. [PMID: 29150160 DOI: 10.1016/j.radonc.2017.10.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 12/21/2022]
|
15
|
De Ruysscher D, Faivre-Finn C, Moeller D, Nestle U, Hurkmans CW, Le Péchoux C, Belderbos J, Guckenberger M, Senan S. European Organization for Research and Treatment of Cancer (EORTC) recommendations for planning and delivery of high-dose, high precision radiotherapy for lung cancer. Radiother Oncol 2017; 124:1-10. [PMID: 28666551 DOI: 10.1016/j.radonc.2017.06.003] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 04/25/2017] [Accepted: 06/05/2017] [Indexed: 12/23/2022]
Abstract
PURPOSE To update literature-based recommendations for techniques used in high-precision thoracic radiotherapy for lung cancer, in both routine practice and clinical trials. METHODS A literature search was performed to identify published articles that were considered clinically relevant and practical to use. Recommendations were categorised under the following headings: patient positioning and immobilisation, Tumour and nodal changes, CT and FDG-PET imaging, target volumes definition, radiotherapy treatment planning and treatment delivery. An adapted grading of evidence from the Infectious Disease Society of America, and for models the TRIPOD criteria, were used. RESULTS Recommendations were identified for each of the above categories. CONCLUSION Recommendations for the clinical implementation of high-precision conformal radiotherapy and stereotactic body radiotherapy for lung tumours were identified from the literature. Techniques that were considered investigational at present are highlighted.
Collapse
Affiliation(s)
- Dirk De Ruysscher
- Maastricht University Medical Center+, Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, The Netherlands; KU Leuven, Radiation Oncology, Belgium.
| | - Corinne Faivre-Finn
- Division of Cancer Sciences University of Manchester, Christie NHS Foundation Trust, UK
| | - Ditte Moeller
- Aarhus University Hospital, Department of Oncology, Denmark
| | - Ursula Nestle
- Freiburg University Medical Center (DKTK partner site), Department of Radiation Oncology, Germany; Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany
| | - Coen W Hurkmans
- Catharina Hospital, Department of Radiation Oncology, Eindhoven, The Netherlands
| | | | - José Belderbos
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | | | - Suresh Senan
- VU University Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands
| |
Collapse
|
16
|
Berthelot K, Thureau S, Giraud P. Détermination des marges du volume cible anatomoclinique au volume cible prévisionnel des cancers bronchiques en radiothérapie conformationnelle tridimensionnelle ou avec modulation d’intensité. Cancer Radiother 2016; 20:616-21. [DOI: 10.1016/j.canrad.2016.08.122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/01/2016] [Indexed: 12/25/2022]
|