Modeling Pancreatic Tumor Motion Using 4-Dimensional Computed Tomography and Surrogate Markers

Huguet, F.; Yorke, Ellen; Davidson, M.; Zhang, Zhigang; Jackson, Andrew; Mageras, G.; Wu, Abraham J.; Goodman, Karyn A.

doi:10.1016/j.ijrobp.2014.10.058

Cited by 31 publications

(24 citation statements)

References 29 publications

(36 reference statements)

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“…For 11 of those patients, simulated respiratory gating with a 50% duty cycle was sufficient to ensure total coverage using 5 mm margins. Another recent work by Huguet et al used 4DCT imaging to measure target motion and simulate gating for 36 pancreatic cancer patients [26]. They saw average±SD ranges of motion of 3±2, 6±3, and 13±7 mm in LR/AP/SI directions, respectively.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of motion mitigation techniques for pancreatic SBRT

Campbell

Jones

Schefter

et al. 2017

Radiotherapy and Oncology

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Background and purpose Ablative radiation therapy can be beneficial for pancreatic cancer, and motion mitigation helps to reduce dose to nearby organs-at-risk. Here, we compared two competing methods of motion mitigation—abdominal compression and respiratory gating. Materials and methods CBCT scans of 19 pancreatic cancer patients receiving stereotactic body radiation therapy were acquired with and without abdominal compression, and 3D target motion was reconstructed from CBCT projection images. Daily target motion without mitigation was compared against motion with compression and with simulated respiratory gating. Gating was free-breathing and based on an external surrogate. Target coverage was also evaluated for each scenario by simulating reduced target margins. Results Without mitigation, average daily target motion in LR/AP/SI directions were 5.3, 7.3, and 13.9 mm, respectively. With abdominal compression, these values were 5.2, 5.3, and 8.5 mm, and with respiratory gating they were 3.2, 3.9, and 5.5 mm, respectively. Reductions with compression were significant in AP/SI directions, while reductions with gating were significant in all directions. Respiratory gating also demonstrated better coverage in the reduced margins scenario. Conclusion Respiratory gating is the most effective strategy for reducing motion in pancreatic SBRT, and may allow for dose escalation through a reduction in target margin.

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Section: Discussionmentioning

confidence: 99%

An evaluation of motion mitigation techniques for pancreatic SBRT

Campbell

Jones

Schefter

et al. 2017

Radiotherapy and Oncology

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“…Doses of 50.4 Gy and 56 Gy in 28 daily fractions were prescribed to the PTV1 and PTV2, respectively. Fifty percent of the patients were treated using respiratory gating for motion management [20]. Respiratory gating used a RPM system software (Varian Medical Systems, Palo Alto, CA) that correlates chest wall motion to the respiration phase.…”

Section: Methodsmentioning

confidence: 99%

Chemotherapy and intensity-modulated radiation therapy for locally advanced pancreatic cancer achieves a high rate of R0 resection*

et al. 2016

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Background To assess local control, survival, and conversion to resectability among locally advanced pancreatic cancer (LAPC) patients treated with induction chemotherapy (ICT) followed by chemoradiotherapy treatment using intensity-modulated radiation therapy (IMRT). Material and Methods Between 2007 and 2012, 134 LAPC patients were treated with ICT followed by IMRT. After chemoradiotherapy, 40 patients received maintenance chemotherapy. Results With a median follow-up of 20 months, median overall survival (OS) was 23 months. One-year and 2-year OS was 85% and 47%, respectively. On multivariate analysis, progression of disease after IMRT was associated with worse overall survival. Cumulative incidence of local failure was 10% at 1 year and 36% at 2 years. Twenty-six patients (19%) underwent resection after chemoradiotherapy including 22 patients (85%) with negative margins. On multivariate analysis, response to IMRT was associated with surgery (p=0.01). Acute grade 3–4 hematologic and non-hematologic toxicity rates were 26% and 4.5%, respectively. Conclusion IMRT is safe in patients with LAPC. Patients with non-progressive LAPC after ICT and who received IMRT had high rates of local control and prolonged survival.

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“…Previously, Huguet et al reported that the correlation between the motion of fiducial markers and the pancreatic tumor motion was greater than the correlation between the motion of abdominal wall surrogate and pancreatic tumor motion. However, in the surrogate‐based treatment using fiducial markers, differences between the motion of the marker and that of other pancreatic regions or OARs adjacent to the pancreas might appear because of the region‐dependent pancreatic motion variation revealed in this study.…”

Section: Discussionmentioning

confidence: 99%

“…To simulate RG when using an abdominal wall surrogate, the duty cycle was defined as 40% of the typical beam duty cycle values . Therefore, for each volunteer, the maximum displacement of the pancreas between end‐expiration (50% phase) and either the 30% or the 70% phase was calculated, as described in previous studies …”

Section: Methodsmentioning

confidence: 99%

Evaluation of the effects of motion mitigation strategies on respiration‐induced motion in each pancreatic region using cine‐magnetic resonance imaging

Fujimoto

Shiinoki

Yuasa

et al. 2019

J Applied Clin Med Phys

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Purpose This study aimed to quantify the respiration‐induced motion in each pancreatic region during motion mitigation strategies and to characterize the correlations between this motion and that of the surrogate signals in cine‐magnetic resonance imaging (MRI). We also aimed to evaluate the effects of these motion mitigation strategies in each pancreatic region. Methods Sagittal and coronal two‐dimensional cine‐MR images were obtained in 11 healthy volunteers, eight of whom also underwent imaging with abdominal compression (AC). For each pancreatic region, the magnitude of pancreatic motion with and without motion mitigation and the positional error between the actual and predicted pancreas motion based on surrogate signals were evaluated. Results The magnitude of pancreatic motion with and without AC in the left–right (LR) and superior–inferior (SI) directions varied depending on the pancreatic region. In respiratory gating (RG) assessments based on a surrogate signal, although the correlation was reasonable, the positional error was large in the pancreatic tail region. Furthermore, motion mitigation in the anterior‐posterior and SI directions with RG was more effective than was that with AC in the head region. Conclusions This study revealed pancreatic region‐dependent variations in respiration‐induced motion and their effects on motion mitigation outcomes during AC or RG. The magnitude of pancreatic motion with or without AC and the magnitude of the positional error with RG varied depending on the pancreatic region. Therefore, during radiation therapy for pancreatic cancer, it is important to consider that the effects of motion mitigation during AC or RG may differ depending on the pancreatic region.

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Modeling Pancreatic Tumor Motion Using 4-Dimensional Computed Tomography and Surrogate Markers

Cited by 31 publications

References 29 publications

An evaluation of motion mitigation techniques for pancreatic SBRT

An evaluation of motion mitigation techniques for pancreatic SBRT

Chemotherapy and intensity-modulated radiation therapy for locally advanced pancreatic cancer achieves a high rate of R0 resection*

Evaluation of the effects of motion mitigation strategies on respiration‐induced motion in each pancreatic region using cine‐magnetic resonance imaging

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