Pancreatic tumor motion reduction by use of a custom abdominal corset

Heerkens, H.D.; Reerink, O.; Intven, Martijn; Hiensch, R.R.; Berg, C.A.T. Van den; Crijns, S.P.M.; Vulpen, Marco van; Meijer, G.J.

doi:10.1016/j.phro.2017.02.003

Cited by 37 publications

(52 citation statements)

References 14 publications

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“…All three corsets evaluated in this study reduced pancreatic motion, in particular in IS direction. Compared to the study by Heerkens et al, investigating the motion reduction by use of a PU corset and reporting a mean IS motion reduction of 4 mm with a large inter‐patient variability, we observed a mean pancreatic motion reduction of around 8 mm in IS direction in a single subject. We additionally observed an AP motion reduction of 3 mm, which was not the case in the previous study .…”

Section: Discussioncontrasting

confidence: 94%

“…Compared to the study by Heerkens et al, investigating the motion reduction by use of a PU corset and reporting a mean IS motion reduction of 4 mm with a large inter‐patient variability, we observed a mean pancreatic motion reduction of around 8 mm in IS direction in a single subject. We additionally observed an AP motion reduction of 3 mm, which was not the case in the previous study . However, as reported in previous corset studies, such results are highly patient‐specific.…”

Section: Discussioncontrasting

confidence: 94%

“…For thoracic and abdominal organs, the main source of motion is respiration. To reduce respiration‐induced uncertainties in PT, breathing motion can be accounted for by 4D treatment planning and optimizations, tumour tracking, gating scenarios, or by physically reducing respiratory‐induced motion by abdominal compression techniques . For PT of targets in the upper gastro‐intestinal tract, including the liver and pancreas, motion mitigation by means of abdominal compression bands or pressure plates can, however, exacerbate the range uncertainties due to a poor setup reproducibility and consequential edge effects of the devices used .…”

Section: Introductionmentioning

confidence: 99%

“…As a solution to reduce breathing induced tumour motion in patients with pancreatic cancer, polyurethane‐based customized abdominal corsets have recently been used in stereotactic XT . Studies using magnetic resonance imaging (MRI) in multi‐planar 2D‐cine or 4D mode have shown the ability of abdominal corsets to reduce pancreatic motion mainly in inferior‐superior direction …”

Section: Introductionmentioning

confidence: 99%

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Comparison of pancreatic respiratory motion management with three abdominal corsets for particle radiation therapy: Case study

Dolde

Schneider

Stefanowicz

et al. 2019

J Applied Clin Med Phys

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Background and purpose Abdominal organ motion seriously compromises the targeting accuracy for particle therapy in patients with pancreatic adenocarcinoma. This study compares three different abdominal corsets regarding their ability to reduce pancreatic motion and their potential usability in particle therapy. Materials and methods A patient‐individualized polyurethane (PU), a semi‐individualized polyethylene (PE), and a patient‐individualized three‐dimensional‐scan based polyethylene (3D‐PE) corset were manufactured for one healthy volunteer. Time‐resolved volumetric four‐dimensional‐magnetic resonance imaging (4D‐MRI) and single‐slice two‐dimensional (2D) cine‐MRI scans were acquired on two consecutive days to compare free‐breathing motion patterns with and without corsets. The corset material properties, such as thickness variance, material homogeneity in Hounsfield units (HU) on computed tomography (CT) scans, and manufacturing features were compared. The water equivalent ratio (WER) of corset material samples was measured using a multi‐layer ionization chamber for proton energies of 150 and 200 MeV. Results All corsets reduced the pancreatic motion on average by 9.6 mm in inferior–superior and by 3.2 mm in anterior‐posterior direction. With corset, the breathing frequency was approximately doubled and the day‐to‐day motion variations were reduced. The WER measurements showed an average value of 0.993 and 0.956 for the PE and 3DPE corset, respectively, and of 0.298 for the PU corset. The PE and 3DPE corsets showed a constant thickness of 2.8 ± 0.2 and 3.8 ± 0.2 mm, respectively and a homogeneous material composition with a standard deviation (SD) of 31 and 32 HU, respectively. The PU corset showed a variable thickness of 4.2 − 25.6 mm and a heterogeneous structure with air inclusions with an SD of 113 HU. Conclusion Abdominal corsets may be effective devices to reduce pancreatic motion. For particle therapy, PE‐based corsets are preferred over PU‐based corset due to their material homogeneity and constant thickness.

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Section: Discussioncontrasting

confidence: 94%

Section: Discussioncontrasting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of pancreatic respiratory motion management with three abdominal corsets for particle radiation therapy: Case study

Dolde

Schneider

Stefanowicz

et al. 2019

J Applied Clin Med Phys

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show abstract

“…To reduce potential intra-fraction motion, patients with lymph node metastases in the pelvic and low para-aortic region were initially immobilized using a vacuum mattress (BlueBAG, Elekta AB, Stockholm, Sweden) with both hands on the chest and the elbows along the body [20]. The patients with affected nodes in the high paraaortic region (above the renal veins) were treated whilst wearing an abdominal corset with the arms along the body [24].…”

Section: Clinical Treatmentmentioning

confidence: 99%

Target coverage and dose criteria based evaluation of the first clinical 1.5T MR-linac SBRT treatments of lymph node oligometastases compared with conventional CBCT-linac treatment

Winkel

Bol

Werensteijn-Honingh

et al. 2020

Radiotherapy and Oncology

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a b s t r a c tBackground and purpose: Patients were treated at our institute for single and multiple lymph node oligometastases on the 1.5T MR-linac since August 2018. The superior soft-tissue contrast and additional software features of the MR-linac compared to CBCT-linacs allow for online adaptive treatment planning. The purpose of this study was to perform a target coverage and dose criteria based evaluation of the clinically delivered online adaptive radiotherapy treatment compared with conventional CBCT-linac treatment. Materials and methods: Patient data was used from 14 patients with single lymph node oligometastases and 6 patients with multiple (2-3) metastases. All patients were treated on the 1.5T MR-linac with a prescribed dose of 5 Â 7 Gy to 95% of the PTV and a CBCT-linac plan was created for each patient. The difference in target coverage between these plans was compared and plans were evaluated based on dose criteria for each fraction after calculating the CBCT-plan on the daily anatomy. The GTV coverage was evaluated based on the online planning and the post-delivery MRI. Results: For both single and multiple lymph node oligometastases the GTV V 35Gy had a median value of 100% for both the MR-linac plans and CBCT-plans pre-and post-delivery and did not significantly differ. The percentage of plans that met all dose constraints was improved from 19% to 84% and 20% to 67% for single and multiple lymph node cases, respectively. Conclusion: Target coverage and dose criteria based evaluation of the first clinical 1.5T MR-linac SBRT treatments of lymph node oligometastases compared with conventional CBCT-linac treatment shows a smaller amount of unplanned violations of high dose criteria. The GTV coverage was comparable. Benefit is primarily gained in patients treated for multiple lymph node oligometastases: geometrical deformations are accounted for, dose can be delivered in one plan and margins can be reduced.

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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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Pancreatic tumor motion reduction by use of a custom abdominal corset

Cited by 37 publications

References 14 publications

Comparison of pancreatic respiratory motion management with three abdominal corsets for particle radiation therapy: Case study

Comparison of pancreatic respiratory motion management with three abdominal corsets for particle radiation therapy: Case study

Target coverage and dose criteria based evaluation of the first clinical 1.5T MR-linac SBRT treatments of lymph node oligometastases compared with conventional CBCT-linac treatment

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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