IGRT Stereotactic Radiotherapy for Liver Metastases: Local Control with or without Implanted Fiducial Markers

Menichelli, C.; Casamassima, F.; Masciullo, S.; Masi, Laura; Doro, R.; Bonucci, I.

doi:10.1016/j.ijrobp.2010.07.722

Cited by 1 publication

(1 citation statement)

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“…Unlike orthogonal planar image verification techniques where only bone anatomy is matched before the treatment, KV-cone beam CT (KV-CBCT) 3 with on board imager (OBI) can give soft tissue volumetric images of patient which can be used to check for internal organ match with respect to reference planning (simulation) CT images. Various studies have been conducted to analyse the internal organ movements using image guided radiotherapy (IGRT) for prostate 4,5,6 , lung 7,8,9 , oesophagus 10,11 , liver 12,13 and pancreas 14,15 . There is a scarcity of studies and literature on volumetric 3-dimensional inter-nal organ movements of tongue for patients with tongue malignancy undergoing radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Study of inter-fraction movements of tongue during radiation therapy in cases of tongue malignancy using volumetric cone beam computed tomography (CBCT) imaging

Ali

Babaiah

Raut

et al. 2015

Int J Cancer Ther Oncol

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Original ArticleAbstract Purpose: Tongue is a mobile organ in head and neck region predisposing it for geographic miss during the course of fractionated radiotherapy for tongue malignancy. This study analyses movement of tongue during the course of radiotherapy using volumetric KV-cone beam computed tomography (KV-CBCT) imaging for patients of tongue malignancy treated without using tongue bite. Methods: We analysed 100 KV-cone beam CTs performed on 10 patients with carcinoma of tongue undergoing fractionated radiotherapy. All the patients underwent thermoplastic mask immobilisation and CT simulation. During the course of radiotherapy, all patients underwent volumetric KV-CBCT imaging to assess the movements of tongue. Five arbitrary reference points were used to analyse the movements of tongue in 3-dimensions: 1) Point A: Tip of tongue; 2) Point B: Point over right lateral border, 4 cm posterior to the tip of tongue; 3) Point C: Point over left lateral border, 4 cm posterior to the tip of tongue; 4) Point D: Point over superior most part (dorsum) of tongue, 4 cm posterior to the tip of tongue; 5) Point E: Point over the surface of base of tongue at the level of tip of epiglottis. Results: Mean movements of point A: +0.21 cm (SD: 0.12) and -0.23 cm (SD: 0.14), point B: +0.14 cm (SD: 0.04) and -0.19 cm (SD: 0.1), point C: +0.12 cm (SD: 0.05) and -0.14 cm (SD: 0.06), point D: +0.15 cm (SD: 0.07) and -0.29 cm (SD: 0.22) and point E: +0.23 cm (SD: 0.15) and -0.23 cm (SD: 0.14). Conclusion: Organ movement is one of the great challenges encountered during radiotherapy. Tongue is one such organ in head and neck region. Concept of internal target volume (ITV) margin which takes into account the internal organ movements should be considered for tongue malignancies. ITV to PTV margin will depend on the setup accuracy, immobilization device and imaging modality utilised for setup verification. In an IGRT (Image Guided Radio Therapy) setup, a PTV margin of 0.3 to 0.5 cm from ITV would be safe.

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