Measuring Interfractional and Intrafractional Motion With Cone Beam Computed Tomography and an Optical Localization System for Lower Extremity Soft Tissue Sarcoma Patients Treated With Preoperative Intensity-Modulated Radiation Therapy

Dickie, Colleen; Parent, Amy; Chung, Peter; Catton, Charles; Craig, Tim; Griffin, Anthony M.; Panzarella, Tony; Ferguson, Peter C.; Wunder, Jay S.; Bell, Robert S.; Sharpe, Michael B.; O’Sullivan, Brian

doi:10.1016/j.ijrobp.2009.09.054

Cited by 37 publications

(17 citation statements)

References 38 publications

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“…If FFF or AW protocol was used, the calculated margins were 10–9 mm in LR and AP direction, and 14–13 m in SI direction, respectively. Dickie et al (38) quantified a uniform margin of 5 mm for lower extremity soft tissue sarcoma, which are lower than ours probably because of different immobilization used.…”

Section: Discussioncontrasting

confidence: 70%

A retrospective tomotherapy image‐guidance study: analysis of more than 9,000 MVCT scans for ten different tumor sites

Sánchez-Rubio

Rodríguez-Romero

Castro

2014

J Applied Clin Med Phys

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The purpose of this study was to quantify the systematic and random errors for various disease sites when daily MVCT scans are acquired, and to analyze alternative off‐line verification protocols (OVP) with respect to the patient setup accuracy achieved. Alignment data from 389 patients (9,418 fractions) treated at ten different anatomic sites with daily image‐guidance (IG) on a helical tomotherapy unit were analyzed. Moreover, six OVP were retrospectively evaluated. For each OVP, the frequency of the residual setup errors and additional margins required were calculated for the treatment sessions without image guidance. The magnitude of the three‐dimensional vector displacement and its frequency were evaluated for all OVP. From daily IG, the main global systematic error was in the vertical direction (4.4–9.4 mm), and all rotations were negligible (less than 0.5°) for all anatomic sites. The lowest systematic and random errors were found for H&N and brain patients. All OVP were effective in reducing the mean systematic error to less than 1 mm and 0.2° in all directions and roll corrections for almost all treatment sites. The treatment margins needed to adapt the residual errors should be increased by 2–5 mm for brain and H&N, around 8 mm in the vertical direction for the other anatomic sites, and up to 19 mm in the longitudinal direction for abdomen patients. Almost 70% of the sessions presented a setup error of 3 mm for OVPs with an imaging frequency above 50%. Only for brain patients it would be feasible to apply an OVP because the residual setup error could be compensated for with a slight margin increase. However, daily imaging should be used for anatomic sites of difficult immobilization and/or large interfraction movement.PACS numbers: 87.55.‐x, 87.56.‐v

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Section: Discussioncontrasting

confidence: 70%

A retrospective tomotherapy image‐guidance study: analysis of more than 9,000 MVCT scans for ten different tumor sites

Sánchez-Rubio

Rodríguez-Romero

Castro

2014

J Applied Clin Med Phys

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“…Patient daily setup accuracy can be improved with the daily image guidance correction [5]. However, the respiratory related target motions are of major concerns for abdominal tumors.…”

Section: Introductionmentioning

confidence: 99%

Incorporating breath holding and image guidance in the adjuvant gastric cancer radiotherapy: a dosimetric study

Wang

et al. 2012

Radiat Oncol

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BackgroundThe respiratory related target motion and setup error will lead to a large margin in the gastric radiotherapy. The purpose of this study is to investigate the dosimetric benefit and the possibility of incorporating the breath-hold (BH) technique with online image-guided radiotherapy in the adjuvant gastric cancer radiotherapy.MethodsSetup errors and target motions of 22 post-operative gastric cancer patients with surgical clips were analyzed. Clips movement was recorded using the digital fluoroscopics and the probability distribution functions (pdf) of the target motions were created for both the free breathing (FB) and BH treatment. For dosimetric comparisons, two intensity-modulated radiotherapy (IMRT) treatment plans, i.e. the free breathing treatment plan (IMRTFB) and the image-guided BH treatment plan (IMRTIGBH) using the same beam parameters were performed among 6 randomly selected patients. Different margins for FB and BH plans were derived. The plan dose map was convoluted with various pdfs of the setup errors and the target motions. Target coverage and dose to organs at risk were compared and the dose-escalation probability was assessed.ResultsThe mean setup errors were 1.2 mm in the superior-inferior (SI), 0.0 mm in the left-right (LR), and 1.4 mm in the anterior-posterior (AP) directions. The mean target motion for the free breathing (vs. BH) was 11.1 mm (vs. 2.2 mm), 1.9 mm (vs. 1.1 mm), and 5.5 mm (vs. 1.7 mm) in the SI, LR, and AP direction, respectively. The target coverage was comparable for all the original plans. IMRTIGBH showed lower dose to the liver compared with IMRTFB (p = 0.01) but no significant difference in the kidneys. Convolved IMRTIGBH showed better sparing in kidneys (p < 0.01) and similar in liver (p = 0.08).ConclusionsCombining BH technique with online image guided IMRT can minimize the organ motion and improve the setup accuracy. The dosimetric comparison showed the dose could be escalated to 54 Gy without increasing the critical organs toxicities, although further clinical data is needed.

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“…The overall intra-fractional SE SD was 1.6 mm ML, 1.6 mm SI and 1.4 mm AP, and the SE SD was 0.7 mm AP, 0.6 mm SI and 0.6 mm AP. Thus, a uniform 5-mm PTV margin seemed adequate for IGRT/IMRT [74].…”

Section: Technique and Volumesmentioning

confidence: 98%

Perioperative irradiation in extremity soft tissue sarcoma

Mahmoud

Wolfson

2011

Expert Review of Anticancer Therapy

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Adjuvant radiotherapy constitutes an important component of the treatment of soft tissue sarcomas. Extremity soft tissue sarcomas constitute a large proportion of this rare mesenchymal tumor. Questions regarding timing, techniques and toxicity come into play about optimizing adjuvant radiotherapy. This article will discuss recent trends and outcomes of perioperative, that is, preoperative and postoperative, irradiation.

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Measuring Interfractional and Intrafractional Motion With Cone Beam Computed Tomography and an Optical Localization System for Lower Extremity Soft Tissue Sarcoma Patients Treated With Preoperative Intensity-Modulated Radiation Therapy

Cited by 37 publications

References 38 publications

A retrospective tomotherapy image‐guidance study: analysis of more than 9,000 MVCT scans for ten different tumor sites

A retrospective tomotherapy image‐guidance study: analysis of more than 9,000 MVCT scans for ten different tumor sites

Incorporating breath holding and image guidance in the adjuvant gastric cancer radiotherapy: a dosimetric study

Perioperative irradiation in extremity soft tissue sarcoma

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