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Suydam CR, Schlussel AT. Management of Oligometastatic Colorectal Cancer. Surg Clin North Am 2024; 104:619-629. [PMID: 38677825 DOI: 10.1016/j.suc.2023.11.011] [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] [Indexed: 04/29/2024]
Abstract
The management of oligometastatic colorectal cancer differs from the treatment of metastatic colorectal cancer, and it is essential that those who treat oligometastatic disease be familiar with the treatment options for these patients. Although definitive treatment is often surgical, there are situations where local therapies such as SBRT or ablative techniques may better serve the patient. Adjuvant therapy should be provided to all patients, and neoadjuvant chemotherapy should be considered as well. The role of immunotherapy is currently limited due to the lack of clinical trials in this area.
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Affiliation(s)
- Camille R Suydam
- Department of General Surgery, 300 East Hospital Road, Fort Eisenhower, GA 30905, USA.
| | - Andrew T Schlussel
- Department of Surgery, Charlie Norwood VA Medical Center, 950 15th Street, Augusta, GA 30901, USA
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Bensenane R, Helfre S, Cao K, Carton M, Champion L, Girard N, Glorion M, Vieira T, Waissi W, Crehange G, Beddok A. Optimizing lung cancer radiation therapy: A systematic review of multifactorial risk assessment for radiation-induced lung toxicity. Cancer Treat Rev 2024; 124:102684. [PMID: 38278078 DOI: 10.1016/j.ctrv.2024.102684] [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: 10/09/2023] [Revised: 12/27/2023] [Accepted: 01/11/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Radiation therapy (RT) is essential in treating advanced lung cancer, but may lead to radiation pneumonitis (RP). This systematic review investigates the use of pulmonary function tests (PFT) and other parameters to predict and mitigate RP, thereby improving RT planning. METHODS A systematic review sifted through PubMed and on BioMed Central, targeting articles from September 2005 to December 2022 containing the keywords: Lung Cancer, Radiotherapy, and pulmonary function test. RESULTS From 1153 articles, 80 were included. RP was assessed using CTCAEv.4 in 30 % of these. Six studies evaluated post-RT quality of life in lung cancer patients, reporting no decline. Patients with RP and chronic obstructive pulmonary disease (COPD) generally exhibited poorer overall survival. Notably, forced expiratory volume in one second (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO) declined 24 months post-RT, while forced vital capacity (FVC) stayed stable. In the majority of studies, age over 60, tumors located in the lower part of the lung, and low FEV1 before RT were associated with a higher risk of RP. Dosimetric factors (V5, V20, MLD) and metabolic imaging emerged as significant predictors of RP risk. A clinical checklist blending patient and tumor characteristics, PFT results, and dosimetric criteria was proposed for assessing RP risk before RT. CONCLUSION The review reveals the multifactorial nature of RP development following RT in lung cancer. This approach should guide individualized management and calls for a prospective study to validate these findings and enhance RP prevention strategies.
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Affiliation(s)
- Rayan Bensenane
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | - Sylvie Helfre
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | - Kim Cao
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | | | | | - Nicolas Girard
- Institut Curie, Department of Thoracic Oncology, Paris, France
| | | | - Thibaut Vieira
- Institut Mutualist Montsouris, Department of Pneumology, Paris, France
| | - Waisse Waissi
- Centre Léon Bérard, Department of Radiation Oncology, Lyon, France
| | - Gilles Crehange
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | - Arnaud Beddok
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France; Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, 91898 Orsay, France.
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Roby NM, Hassan M, Aboelkasem MA, Kamaleldin M, Ali AS. Factors that Influence the Need to Start Adaptive Radiotherapy. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2024; 7:18-23. [PMID: 38327756 PMCID: PMC10846639 DOI: 10.36401/jipo-23-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/03/2023] [Accepted: 11/07/2023] [Indexed: 02/09/2024]
Abstract
Introduction Adaptive radiotherapy (ART) is an essential approach to account for anatomical and biological uncertainties. Adaptive radiotherapy is, however, time-consuming, and it is unclear which patients are eligible or when is the best time to start ART. Methods This prospective study was conducted at Kasr El-Aini Center of Clinical Oncology and Nuclear Medicine, Cairo, Egypt from January 2019 to December 2020. Thirty patients with pathologically proven, limited-stage small cell or stage I-II non-small cell lung cancer who were either not fit for or refused surgery or had stage III disease were recruited and underwent treatment planning to receive 60 Gy on a conventional 3D conformal radiation schedule with platinum-based chemotherapy. All patients underwent computed tomography (CT) planning within 2 and 4 weeks of starting radiation therapy to assess the need for adaptation. Pulmonary function test and echocardiography findings were assessed at the end of treatment and at 3 and 6 months after treatment, and were compared to the baseline. Results We found a significant reduction in mean value of the planning target volume (PTV) in the CT scans at the second (331 cm3) and fourth (257 cm3) weeks of treatment as compared to baseline (342 cm3) (p-value < 0.0001). Adaptation decreased the dose to the organ at risk with statistical significance and with improvement of the target coverage. At week 2 of radiotherapy, the need for adaptation was correlated to the conformity index (p = 0.0473), esophageal V35 (p = 0.0488), esophageal V50 (p = 0.0295), and its mean dose (p = 0.0087). At week 4 it was correlated to forced expiratory volume in 1 second (FEV1) (p = 0.0303), ratio between the forced expiratory volume in 1 second and the forced vital capacity (FEV1/FVC) (p = 0.0024), and echocardiography (p = 0.0183). Conclusions Conformity index and esophageal dose constraints can predict the need for adaptation at week 2, whereas baseline pulmonary function parameters and echocardiography can predict the need for adaptation at week 4 of radiotherapy.
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Affiliation(s)
| | - Mohamed Hassan
- Kasr El-Aini Center of Clinical Oncology and Nuclear Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A. Aboelkasem
- Kasr El-Aini Center of Clinical Oncology and Nuclear Medicine, Cairo University, Cairo, Egypt
| | - Maha Kamaleldin
- Kasr El-Aini Center of Clinical Oncology and Nuclear Medicine, Cairo University, Cairo, Egypt
| | - Ahmed S. Ali
- Kasr El-Aini Center of Clinical Oncology and Nuclear Medicine, Cairo University, Cairo, Egypt
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Ahn J, Yeghiaian-Alvandi R, Hegi-Johnson F, Browne LH, Graham PH, Chin Y, Gee H, Vinod S, Ludbrook J, Last A, Dwyer P, Ong A, Aherne N, Azzi M, Hau E. SABR for Early Non-Small Cell Lung Cancer: Changes in Pulmonary Function, Dyspnea, and Quality of Life. Int J Radiat Oncol Biol Phys 2023; 117:1213-1221. [PMID: 37482136 DOI: 10.1016/j.ijrobp.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/29/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE The aim of this study was to report pulmonary function tests (PFTs) and clinician-reported and patient-reported quality-of-life (QoL) outcomes on a cohort of patients with non-small cell lung cancer (NSCLC) treated with SABR. METHODS AND MATERIALS A total of 119 patients with NSCLC were treated with SABR in the prospective cohort SSBROC study of patients with T1-T2N0M0 NSCLC. PFTs and QoL measures were obtained at baseline pretreatment and at 6-month intervals. Here we report on the 6- to 18-month time points. Analysis of covariance (ANCOVA) methods adjusting for baseline analyzed potential predictors on outcomes of PFTs and patient-reported dyspnea at 18 months. RESULTS The only statistically significant decline in PFTs was seen in forced expiratory volume in 1 second (FEV1) at 18 months post-SABR, with a decline of -0.11 L (P = .0087; 95% CI, -0.18 to -0.02). Of potential predictors of decline, only a 1-unit increase in smoking pack-years resulted in a -0.12 change in diffusing capacity for carbon monoxide (P = .026; 95% CI, -0.02 to -0.23) and a 0.003 decrease in FEV1 (P = .026; 95% CI, -0.006 to -0.0004). For patient-reported outcomes, statistically significant worsening in both the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (QLQ-C30 Version 3) and the lung module (QLQ-LC13) dyspnea scores occurred at the 18-month time point, but not earlier. No potential predictors of worsening dyspnea were statistically significant. There was no statistically significant decline in clinician-reported outcomes or global QoL scores. CONCLUSIONS We found a statistically significant decline in FEV1 at 18 months posttreatment. Smoking pack-years was a predictor for decline in diffusing capacity for carbon monoxide and FEV1 at 18 months. Worsening of patient-reported dyspnea scores was observed, consistent with the expected progression of lung comorbid disease.
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Affiliation(s)
- Julie Ahn
- Sydney West Radiation Oncology Network (SWRON), Sydney, New South Wales, Australia.
| | - Roland Yeghiaian-Alvandi
- Department of Radiation Oncology, Nepean Cancer Centre, Sydney, New South Wales, Australia; Department of Radiation Oncology, Central Coast Cancer Centre, Gosford, New South Wales, Australia
| | - Fiona Hegi-Johnson
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Clinical Oncology, University of Melbourne, Victoria, Australia
| | - Lois H Browne
- Department of Radiation Oncology, Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia
| | - Peter Henry Graham
- Department of Radiation Oncology, Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Yaw Chin
- Department of Radiation Oncology, Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia; GenesisCare, Sydney, New South Wales, Australia
| | - Harriet Gee
- Sydney West Radiation Oncology Network (SWRON), Sydney, New South Wales, Australia; Children's Medical Research Institute (CMRI), University of Sydney, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
| | - Shalini Vinod
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, New South Wales, Australia
| | - Jane Ludbrook
- Department of Radiation Oncology, Calvary Mater Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Andrew Last
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Patrick Dwyer
- University of Sydney, Sydney, New South Wales, Australia; Department of Radiation Oncology, Northern NSW Cancer Institute, Lismore, New South Wales, Australia
| | - Anselm Ong
- Sydney West Radiation Oncology Network (SWRON), Sydney, New South Wales, Australia
| | - Noel Aherne
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Maria Azzi
- Department of Radiation Oncology, Nepean Cancer Centre, Sydney, New South Wales, Australia
| | - Eric Hau
- Sydney West Radiation Oncology Network (SWRON), Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia; Westmead Institute of Medical Research, Sydney, New South Wales, Australia
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Bucknell NW, Kron T, Herschtal A, Hardcastle N, Irving L, MacManus M, Hanna GG, Moore A, Murnane A, Siva S, Ball D. Comparison of Changes in Pulmonary Function After Stereotactic Body Radiation Therapy Versus Conventional 3-Dimensional Conformal Radiation Therapy for Stage I and IIA Non-Small Cell Lung Cancer: An Analysis of the TROG 09.02 (CHISEL) Phase 3 Trial. Int J Radiat Oncol Biol Phys 2023; 117:378-386. [PMID: 37087060 DOI: 10.1016/j.ijrobp.2023.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023]
Abstract
PURPOSE The TROG 09.02 CHISEL trial compared conventional radiation therapy (CRT) with stereotactic body radiation therapy (SBRT) in patients with inoperable early-stage non-small cell lung cancer. Patients randomized to SBRT had less local failure and improved overall survival. This analysis reports differences in pulmonary function tests (PFTs) and the 6-minute walk test (SMWT) between patients who received SBRT and those who received CRT. METHODS AND MATERIALS We analyzed the PFTs and SMWTs of all patients recruited to the CHISEL [trial. During this trial, patients underwent serial PFTs. Linear regression models were used to compare parameters between SBRT and CRT at 3 and 12 months after treatment. RESULTS One hundred and one patients were enrolled; 33 patients were treated with CRT, 61 were treated with SBRT, and 7 did not receive treatment. Primary tumor size was similar between arms: SBRT 25 mm (standard deviation [SD], 9) and CRT 28 mm (SD, 9). On regression analysis, at 3 and 12 months, there was no evidence of a difference between arms in PFT decline or distance walked in the SMWT. Planning target volume size was significantly larger in the CRT arm, 142.79 cc (SD, 61.14), compared with the SBRT group, 46.15 cc (SD, 23.39). The mean biologically effective dose received by the target was significantly larger in the SBRT group, 125.92 Gy (SD, 21.58), compared with CRT, 65.49 Gy (SD, 6.32). Mean dose to the lungs minus the gross target volume incorporating motion was 8.9 Gy (SD, 2.34) in the CRT group and 4.37 Gy (SD, 1.42) in the SBRT group. CONCLUSIONS Despite the considerably higher biologically effective doses delivered to the tumor in SBRT, there was no difference in decline in respiratory function observed between the 2 groups.
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Affiliation(s)
- Nicholas W Bucknell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
| | - Tomas Kron
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alan Herschtal
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Nicholas Hardcastle
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Louis Irving
- Department of Respiratory Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Alisha Moore
- TROG Cancer Research, Waratah, New South Wales, Australia
| | - Andrew Murnane
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - David Ball
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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Mesny E, Ayadi M, Dupuis P, Beldjoudi G, Tanguy R, Martel-Lafay I. Clinical outcomes and lung toxicities after lung SABR using dynamic conformal arc therapy: a single-institution cohort study. Radiat Oncol 2023; 18:36. [PMID: 36814265 PMCID: PMC9948312 DOI: 10.1186/s13014-023-02227-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Stereotactic ablative radiotherapy (SABR) is a validated treatment for early stage lung cancer and pulmonary metastases. It provides a high local control rate with low symptomatic toxicities. Recently, Dynamic Conformal Arc Therapy (DCAT), a delivery option that differs from conventional DCA, has been implemented in the Monaco Treatment Planning System for SABR. The aim of the study was to report clinical outcomes and toxicities for patients treated for lung SABR with this new technique. METHODS We retrospectively identified adult patients treated for primary or secondary lung tumors with DCAT-SABR and reported their clinical, radiological, histological characteristics and dosimetric parameters. Total dose was delivered in 3 or 5 fractions for 95% of patients and prescribed on the 80% isodose line to the PTV periphery. RESULTS 145 patients met inclusion criteria for a total of 152 lesions with a median follow up of 12 months. Local control for the irradiated site was 96.7% at 1 year. Overall survival was 93.1% at 1 year. Mean prescription dose in BED10 was 110 Gy. 92% of patients had a prescribed dose superior to 100 Gy BED10. Mean PTV coverage was 95.1%. There were 66 cases of grade 1 radiation pneumonitis (RP) (43%) and only 7 cases of symptomatic grade 2 RP (4.6%). CONCLUSION Lung SABR for primary or metastatic lung tumors using dynamic conformal arc therapy provides efficient results of local control and low lung toxicities, similar to other SABR techniques. ADVANCES IN KNOWLEDGE SABR using DCAT is a safe technique to treat lung lesions, allowing intra-fraction motion limitation, potentially higher OARs protection and a shortened beam delivery.
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Affiliation(s)
- Emmanuel Mesny
- Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France.
| | - Myriam Ayadi
- grid.418116.b0000 0001 0200 3174Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Pauline Dupuis
- grid.418116.b0000 0001 0200 3174Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Guillaume Beldjoudi
- grid.418116.b0000 0001 0200 3174Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Ronan Tanguy
- grid.418116.b0000 0001 0200 3174Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Isabelle Martel-Lafay
- grid.418116.b0000 0001 0200 3174Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
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Tanabe Y, Tanaka H. Statistical evaluation of the effectiveness of dual amplitude-gated stereotactic body radiotherapy using fiducial markers and lung volume. Phys Imaging Radiat Oncol 2022; 24:82-87. [PMID: 36267878 PMCID: PMC9576976 DOI: 10.1016/j.phro.2022.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
Approximately 30% of the fiducial markers demonstrated a low correlation on comparing lung volumes. Monitoring of lung volume can achieve stable tracking of lung tumors. Dual monitoring by employing the marker and lung volume may possibly avoid the deterioration of monitoring accuracy.
Background and purpose The low tracking accuracy of lung stereotactic body radiotherapy (SBRT) risks reduced treatment efficacy. We used four-dimensional computed tomography (4DCT) images to determine the correlation between changes in fiducial marker positions and lung volume for lung tumors, and we evaluated the effectiveness of the combined use of these images in lung SBRT. Materials and methods Data of 30 patients who underwent fiducial marker placement were retrospectively analyzed. We calculated the motion amplitudes of the center of gravity coordinates of the lung tumor and fiducial markers in each phase and the ipsilateral, contralateral, and bilateral lung volumes using 4DCT. Moreover, we calculated the cross-correlation coefficient between the fiducial marker position and the lung volume changes waveform for the motion amplitude waveform of the lung tumor over three gating windows (all phases, ≤2 mm3, and ≤3 mm3). Results Compared with the lung volume, approximately 30 % of the fiducial markers demonstrated a low correlation with the lung tumor. In the ≤2 mm3 and ≤3 mm3 gating windows, the cross-correlation coefficients between the lung tumor and the optimal marker (r > 0.9: 83 % and 86 %) were significantly different for all fiducial markers (r > 0.9: 39 %, 53 %) and the ipsilateral (r > 0.9: 35 % and 40 %), contralateral (r > 0.9: 44 % and 41 %), and bilateral (r > 0.9: 39 % and 45 %) lung volumes. Conclusions Some of the fiducial markers showed a low correlation with the lung tumor. This study indicated that the combined use of lung volume monitoring can improve tracking accuracy.
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Affiliation(s)
- Yoshinori Tanabe
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama-shi, 700-8558, Japan,Corresponding author.
| | - Hidekazu Tanaka
- Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
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