A feasibility trial of skin surface motion-gated stereotactic body radiotherapy for treatment of upper abdominal or lower thoracic targets using a novel O-ring gantry

Kiser, Kendall; Schiff, Joshua; Laugeman, Eric; Kim, Taeho; Green, Olga; Hatscher, Casey; Kim, Hyun; Badiyan, Shahed; Spraker, Matthew; Samson, Pamela; Robinson, Clifford; Price, Alex; Henke, Lauren

doi:10.1016/j.ctro.2023.100692

Cited by 2 publications

(2 citation statements)

References 24 publications

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“…A 5-mm expansion from the GTV was used to delineate the planning target volume (PTV). Intra-fraction motion management was conducted via end-exhale breath-hold using a surface-guided monitoring system, which has previously been described [ 13 ]; therefore, an internal target volume was not used.…”

Section: Case Presentationmentioning

confidence: 99%

The First Reported Case of Treating the Ultra-Central Thorax With Cone Beam Computed Tomography-Guided Stereotactic Adaptive Radiotherapy (CT-STAR)

Zhao,

Beckert,

Zhao

et al. 2024

Cureus

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Stereotactic body radiotherapy (SBRT) to the central and ultra-central thorax is associated with infrequent but potentially serious adverse events. Adaptive SBRT, which provides more precise treatment planning and inter-fraction motion management, may allow the delivery of ablative doses to ultra-central tumors with effective local control and improved toxicity profiles. Herein, we describe the first reported case of cone beam computed tomography (CBCT)-guided stereotactic adaptive radiotherapy (CT-STAR) in the treatment of ultra-central non-small cell lung cancer (NSCLC) in a prospective clinical trial (NCT05785845). An 80-year-old man with radiographically diagnosed early-stage NSCLC presented for definitive management of an enlarging ultra-central lung nodule. He was prescribed 55 Gy in five fractions with CT-STAR. A simulation was performed using four-dimensional CT, and patients were planned for treatment at end-exhale breath-hold. Treatment plans were generated using a strict isotoxicity approach, which prioritized organ at risk (OAR) constraints over target coverage. During treatment, daily CBCTs were acquired and used to generate adapted contours and treatment plans based on the patient’s anatomy-of-the-day, all while the patient was on the treatment table. The initial and adapted plans were compared using dose-volume histograms, and the superior plan was selected for treatment. The adapted plan was deemed superior and used for treatment in three out of five fractions. The adapted plan provided improved target coverage in two fractions and resolved an OAR hard constraint violation in one fraction. We report the successful treatment of a patient with ultra-central NSCLC utilizing CT-STAR. This case report builds on previously published in silico data to support the viability and dosimetric advantages of CT-STAR in the ablative treatment of this challenging tumor location. Further data are needed to confirm the toxicity and efficacy of this technique.

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Section: Case Presentationmentioning

confidence: 99%

The First Reported Case of Treating the Ultra-Central Thorax With Cone Beam Computed Tomography-Guided Stereotactic Adaptive Radiotherapy (CT-STAR)

Zhao,

Beckert,

Zhao

et al. 2024

Cureus

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“…A therapeutic beam is delivered while the patientʹs skin is within a certain tolerance window since it can be verified that while the skin is within that window, the lesion remains within the planned volume. Optical surface guidance is not only efficient for gated treatments of targets near the skin surface, for example breast [12][13][14], but also for gated treatments of intrathoracic and abdominal targets, such as lung or liver lesions [15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Optimizing choice of skin surrogates for surface guided stereotactic body radiotherapy of lung lesions using four-dimensional computed tomography

Leipold,

Alerić,

Mlinarić

et al. 2024

Preprint

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Image-guided radiotherapy supported by surface guidance can help track lower lung lesion respiratory motion while reducing a patient’s exposure to ionizing radiation. However, it is not always clear how skin respiratory motion magnitudes and correlations with lung lesion respiratory motion vary between different skin regions of interest (ROI). Four-dimensional Computed Tomography (4DCT) images provide information on both skin and lung respiratory motion and are routinely acquired for the purpose of treatment planning in our institution. Analysis of 4DCT images for 57 patients treated in our institution has been conducted to provide information on respiratory motion magnitudes of nine skin ROIs of the torso, a tracking structure (TS) representing lower lung lobe lesion, as well as respiratory motion correlations between nine ROIs and TS. The effects of gender and adipose tissue volume and distribution on these correlations and magnitudes have been analyzed. Significant differences between ROIs in both respiratory motion magnitudes and correlations to TS have been detected. An overall negative correlation between ROI respiratory magnitudes and the adipose tissue has been detected for ROIs with rib cage support. A weak to moderate negative correlation between adipose tissue volume and ROI-to-TS respiratory correlations has been detected for upper thorax ROIs. Respiratory magnitudes in regions without rib support tended to be larger for men than for women, but no differences in ROI-to-TS correlation between sexes have been detected. Described findings should be considered when choosing skin surrogates for lower lung lesion motion management.

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A feasibility trial of skin surface motion-gated stereotactic body radiotherapy for treatment of upper abdominal or lower thoracic targets using a novel O-ring gantry

Cited by 2 publications

References 24 publications

The First Reported Case of Treating the Ultra-Central Thorax With Cone Beam Computed Tomography-Guided Stereotactic Adaptive Radiotherapy (CT-STAR)

The First Reported Case of Treating the Ultra-Central Thorax With Cone Beam Computed Tomography-Guided Stereotactic Adaptive Radiotherapy (CT-STAR)

Optimizing choice of skin surrogates for surface guided stereotactic body radiotherapy of lung lesions using four-dimensional computed tomography

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