Interfraction and Respiratory Organ Motion During Conformal Radiotherapy in Gastric Cancer

Wysocka, Barbara; Kassam, Zahra; Lockwood, Gina; Brierley, James D.; Dawson, Laura A.; Buckley, C.A.; Jaffray, David A.; Cummings, Bernard; Kim, John; Wong, Rebecca; Ringash, Jolie

doi:10.1016/j.ijrobp.2009.04.046

Cited by 95 publications

(87 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These sizeable motions agree with existing data concerning kidney movement due to breathing motion and corroborate the choice to use an ITV for target localization. (6,7,9–11) The residual setup error determined from the on‐line CBCT (

normaln = 151

) alignment corresponds with the absolute motion of the kidneys where the greatest error in localization accuracy occurred in the y direction (superior–inferior) compared to the x (left–right) and z (anterior–posterior) directions, consistent with studies in the literature 8 , 12 . Despite patient immobilization in the dual‐vacuum‐cushion system this observation illustrates that the impact of breathing motion on target localization remains clinically significant and strategies to further reduce kidney motion will be investigated.…”

Section: Discussionsupporting

confidence: 82%

Evaluation of kidney motion and target localization in abdominal SBRT patients

Sonier

Chu

Lalani

et al. 2016

J Applied Clin Med Phys

View full text Add to dashboard Cite

The purpose of this study was to evaluate bilateral kidney and target translational/rotational intrafraction motion during stereotactic body radiation therapy treatment delivery of primary renal cell carcinoma and oligometastatic adrenal lesions for patients immobilized in the Elekta BodyFIX system. Bilateral kidney motion was assessed at midplane for 30 patients immobilized in a full‐body dual‐vacuum‐cushion system with two patients immobilized via abdominal compression. Intrafraction motion was assessed for 15 patients using kilovoltage cone‐beam computed tomography (kV‐CBCT) datasets (normaln=151) correlated to the planning CT. Patient positioning was corrected for translational and rotational misalignments using a robotic couch in six degrees of freedom if setup errors exceeded 1 mm and 1°. Absolute bilateral kidney motion between inhale and exhale 4D CT imaging phases for left–right (LR), superior–inferior (SI), and anterior–posterior (AP) directions was 1.51±1.00.15emmm,8.10±4.33.15emmm, and 3.08±2.11.15emmm, respectively. Residual setup error determined across CBCT type (pretreatment, intrafraction, and post‐treatment) for x (LR), y (SI), and z (AP) translations was 0.63±0.74.15emmm,1.08±1.38.15emmm, and 0.70±1.00.15emmm; while for x (pitch), y (roll), and z (yaw) rotations was 0.24±0.39°,0.19±0.34°, and 0.26±0.43°, respectively. Targets were localized to within 2.1 mm and 0.8° 95% of the time. The frequency of misalignments in the y direction was significant (p<0.05) when compared to the x and z directions with no significant difference in translations between IMRT and VMAT. This technique is robust using BodyFIX for patient immobilization and reproducible localization of kidney and adrenal targets and daily CBCT image guidance for correction of positional errors to maintain treatment accuracy.PACS number(s): 87.55.‐x, 87.56.‐v, 87.56.Da

show abstract

normaln = 151

Section: Discussionsupporting

confidence: 82%

Evaluation of kidney motion and target localization in abdominal SBRT patients

Sonier

Chu

Lalani

et al. 2016

J Applied Clin Med Phys

View full text Add to dashboard Cite

show abstract

“…IMRT and image-guided radiotherapy (IGRT) have been demonstrated to be feasible approaches for delivering chemoradiation with improved dose coverage to the target volumes, and further sparing of organs at risk [28][29][30][31]. In our center, IGRT with respiratory control (either by gating or breath-hold) has been implemented routinely since 2008, aiming to reduce the effect of organ motion.…”

Section: Secondary Malignancymentioning

confidence: 99%

Adjuvant chemoradiation for resected gastric cancer: a 10-year experience

Chang

Law

et al. 2011

Gastric Cancer

View full text Add to dashboard Cite

Background The Intergroup 0116 study demonstrated that concurrent chemoradiation improved overall survival (OS) in resected gastric cancer. However, there are few reports focusing on late toxicity and factors governing prognosis. This study aimed to determine these two important aspects for employing this regimen. Methods Patients with resected gastric cancer stage IB to IV (M0) disease, treated between July 1998 and December 2007, were analyzed. The majority of the patients were treated using 5 cycles of 5-fluorouracil (5FU)/leucovorin chemotherapy with 45 Gy/25 fractions radiotherapy concurrent with cycles 2 and 3, as per the Intergroup 0116 study. Results We treated 120 patients (107 standard protocol, 13 with concurrent 5FU alone), and 14% had a close or positive margin. Median age was 59 years (35-79 years). Acute toxicity C grade 3 was seen in 66% of all patients (hematological 61%, stomatitis 3%, diarrhea 6%, vomiting 2%). Median follow-up was 33 months (range 6-125 months). Five-year OS and relapse-free survival were 51 and 54%, respectively. On multivariate analysis, surgical margin status, stage of the disease, and radiotherapy with computed tomography (CT) planning were important prognostic factors. Anemia and gastritis were the two most frequently occurring late complications, though they were usually mild and asymptomatic. Clinically significant renal impairment was uncommon. Other rare complications included intestinal obstruction, malabsorption, hypertension, and secondary malignancy. Conclusions Postoperative chemoradiation is safe and late toxicity is usually mild in extent. Results were comparable to the Intergroup 0116 study. R0 resection is of utmost importance and radiotherapy should best be delivered by conformal techniques.

show abstract

“…Meanwhile, interfraction positional variations of

\geq 10 mm

were observed in 5 fractions (3.0%) in the SI direction, although visual feedback resulted in a lower positional uncertainty in the SI direction compared with pancreatic tumor motion under free breathing. Possible causes of interfraction positional variations in pancreatic tumors involve EE‐BH failure and daily variations in the surrounding organ fillings, including the stomach and bowel 17 , 18 , 19 , 20 , 21 . Although none of our patients consumed anything orally, with the exception of drugs or water, for

\geq 3 hr

before each BH‐CT scan, control of such physiological phenomena would be difficult.…”

Section: Discussionmentioning

confidence: 95%

“…Shinohara et al (12) showed that the mean absolute shifts were 4.5, 3.9, and 6.4 mm in the LR, AP, and SI directions, respectively. Meanwhile, Wysocka et al (20) employed voluntary expiration BH and showed that the 90th percentiles of the interfraction positional variations in the pancreas were 8.9, 7.9, and 23.0 mm in the LR, AP, and SI directions, respectively. Compared with the results of these studies, our method using visual feedback appeared to be effective in reducing interfraction positional variation, even using external surrogates.…”

Section: Discussionmentioning

confidence: 99%

“…However, the intra‐ and interfraction positional variations were based on three repeat CT scans at an interval of one to two weeks during the chemoradiation course. GI content, bowel gas, and other GI states generally vary with time, potentially affecting pancreatic tumor positions 17 , 18 , 19 , 20 , 21 . Therefore, it is important to verify the daily target position, especially in hypofractionated radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Interfraction positional variation in pancreatic tumors using daily breath‐hold cone‐beam computed tomography with visual feedback

Nakamura

Akimoto

Ono

et al. 2015

J Applied Clin Med Phys

View full text Add to dashboard Cite

We assessed interfraction positional variation in pancreatic tumors using daily breath‐hold cone‐beam computed tomography at end‐exhalation (EE) with visual feedback (BH‐CBCT). Eleven consecutive patients with pancreatic cancer who underwent BH intensity‐modulated radiation therapy with visual feedback were enrolled. All participating patients stopped oral intake, with the exception of drugs and water, for >3 hr before treatment planning and daily treatment. Each patient was fixed in the supine position on an individualized vacuum pillow. An isotropic margin of 5 mm was added to the clinical target volume to create the planning target volume (PTV). The prescription dose was 42 to 51 Gy in 15 fractions. After correcting initial setup errors based on bony anatomy, the first BH‐CBCT scans were performed before beam delivery in every fraction. BH‐CBCT acquisition was obtained in three or four times breath holds by interrupting the acquisition two or three times, depending on the patient's BH ability. The image acquisition time for a 360° gantry rotation was approximately 90 s, including the interruption time due to BH. The initial setup errors were corrected based on bony structure, and the residual errors in the target position were then recorded. The magnitude of the interruptions variation in target position was assessed for 165 fractions. The systematic and random errors were 1.2 and 1.8 mm, 1.1 and 1.8 mm, and 1.7 and 2.9 mm in the left–right (LR), anterior–posterior (AP), and superior–inferior (SI) directions, respectively. Absolute interfraction variations of >5 mm were observed in 18 fractions (11.0%) from seven patients because of EE‐BH failure. In conclusion, target matching is required to correct interfraction variation even with visual feedback, especially to ensure safe delivery of escalated doses to patients with pancreatic cancer.PACS number: 87.57.Q‐, 87.57.‐s, 87.55.Qr

show abstract

Interfraction and Respiratory Organ Motion During Conformal Radiotherapy in Gastric Cancer

Cited by 95 publications

References 32 publications

Evaluation of kidney motion and target localization in abdominal SBRT patients

Evaluation of kidney motion and target localization in abdominal SBRT patients

Adjuvant chemoradiation for resected gastric cancer: a 10-year experience

Interfraction positional variation in pancreatic tumors using daily breath‐hold cone‐beam computed tomography with visual feedback

Contact Info

Product

Resources

About