Evaluation of PTV Margin in the Treatment of Lung Cancer Simulated With 4D CT and Validated With Daily Cone Beam CT Guidance

Jennelle, R.; Mourad, W.F.; Shoo, A.; Yang, Cui; Liu, T.; Wilder, Joseph R.; Otts, Jeremy; Vijayakumar, S.; Packianathan, Satyaseelan; Caudell, Jimmy J.

doi:10.1016/j.ijrobp.2013.06.1902

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“…The study concluded that a margin between 5 and 11 mm should be adequate to ensure coverage in patients who are planned using 4D CT simulation but who are not treated with daily cone beam CT-guided IGRT. 11 In another study by Helen et al, they assessed 3D tumor motion and ITV using 4D CT for radiotherapy of lung cancer. Respiration-induced tumor motion was analyzed for 166 tumors from 152 lung cancer patients, 57.2% of whom The expiratory phase of 4D CT images were used as reference set to delineate GTV.…”

Section: Discussionmentioning

confidence: 99%

Use of 4-Dimensional Cone Beam Computed Tomography Scan to Estimate the Planning Target Volume Margin in Lung Tumors

Reddy

Shivananjappa

S.N

et al. 2020

ASJO

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Abstract Introduction This study aimed to estimate the planning target volume (PTV) margin in lung tumors using 4D computed tomography (CT) scan and evaluate other factors that have an effect on tumor motion. Materials and Methods We recruited 43 biopsy-proven, newly diagnosed carcinoma lung patients who were treated with definitive intent from January 2017 to June 2018. The radiation dose was delivered using a 3D conformal radiation therapy (CRT)/intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) plan to a dose of 6000 to 6600 cGy in 30 or more fractions to the whole primary. All patients underwent 4D CT scan on the Elekta machine where all the 10 phases of respiration in free breathing were recorded. These phases are fused with CT simulation images, on which gross tumor volume (GTV) and clinical target volume (CTV) are contoured in all phases of respiration. Following this, an internal target volume (ITV) was created by measuring tumor motion all the directions from the center of tumor and PTV was concluded. Results The mean ITV for tumor in all six directions, that is, in superior, inferior, anterior, posterior, medial and lateral directions was 0.9, 0.9, 0.8, 0.9, 0.8, and 0.9 cm, respectively. For coverage of tumor for 90% of patients, the margins required in superior, inferior, anterior, posterior, medial, and lateral directions were 1.3, 1.5, 1.5, 1.4, 1.5, and 1.3 cm, respectively. Other factors such as size of the tumor and location of the tumor did not significantly contribute to PTV changes in our study. Conclusion Mean ITV for tumor in all six directions summed up to be 0.8 cm, but there was significant movement in inferior direction for upper lobe tumors (0.9 cm) (p = 0.008), in medial direction for middle lobe tumors (0.8 cm) (p = 0.05), and in medial direction for lower lobe tumors (0.75 cm) (p = 0.005).

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Section: Discussionmentioning

confidence: 99%