The effectiveness of an immobilization device in conformal radiotherapy for lung tumor: reduction of respiratory tumor movement and evaluation of the daily setup accuracy

Negoro, Yuji; Nagata, Yasushi; Aoki, Takeshi; Mizowaki, Takashi; Araki, Norio; Takayama, Kenji; Kitajima, Masaki; Yano, Shinsuke; Koga, Sachiko; Sasai, Keisuke; Shibamoto, Yuta; Hiraoka, Masahiro

doi:10.1016/s0360-3016(01)01516-4

Cited by 203 publications

(137 citation statements)

References 14 publications

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“…Negoro et al (10) have found that a correction of the patient's setup was required in 25% (20/80) with the absolute errors from 4 to 8 mm (mean 4.9 mm) by daily film verification in 18 cases using a stereotactic body frame (SBF).…”

Section: Discussionmentioning

confidence: 99%

“…Initially, a stereotactic localization system affixed to the patient immobilization system was utilized to set up the target volume, and thereafter the bony anatomy such as vertebral bones was used as a surrogate landmark of the tumor. Errors in the patient setup with 2D portal imaging based on the bony anatomy have been evaluated by kilovoltage (kV) radiographs or cone-beam computed tomography (CBCT) (6,10,11). Recently, it was reported that the tumor shadow itself was utilized in the setup with CBCT (9,12).…”

Section: Introductionmentioning

confidence: 99%

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Influence of Rotational Setup Error on Tumor Shift in Bony Anatomy Matching Measured with Pulmonary Point Registration in Stereotactic Body Radiotherapy for Early Lung Cancer

Сузукі

Nishiyama

Ueda

et al. 2012

Japanese Journal of Clinical Oncology

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Objective: To examine the correlation between the patient rotational error measured with pulmonary point registration and tumor shift after bony anatomy matching in stereotactic body radiotherapy for lung cancer. Methods: Twenty-six patients with lung cancer who underwent stereotactic body radiotherapy were the subjects. On 104 cone-beam computed tomography measurements performed prior to radiation delivery, rotational setup errors were measured with point registration using pulmonary structures. Translational registration using bony anatomy matching was done and the three-dimensional vector of tumor displacement was measured retrospectively. Correlation among the three-dimensional vector and rotational error and vertebra -tumor distance was investigated quantitatively. Results: The median and maximum rotational errors of the roll, pitch and yaw were 0.8, 0.9 and 0.5, and 6.0, 4.5 and 2.5, respectively. Bony anatomy matching resulted in a 0.2 -1.6 cm three-dimensional vector of tumor shift. The shift became larger as the vertebra -tumor distance increased. Multiple regression analysis for the three-dimensional vector indicated that in the case of bony anatomy matching, tumor shifts of 5 and 10 mm were expected for vertebra -tumor distances of 4.46 and 14.1 cm, respectively. Conclusions: Using pulmonary point registration, it was found that the rotational setup error influences the tumor shift. Bony anatomy matching is not appropriate for hypofractionated stereotactic body radiotherapy with a tight margin.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of Rotational Setup Error on Tumor Shift in Bony Anatomy Matching Measured with Pulmonary Point Registration in Stereotactic Body Radiotherapy for Early Lung Cancer

Сузукі

Nishiyama

Ueda

et al. 2012

Japanese Journal of Clinical Oncology

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“…Accurate tumor localization is essential for small intracranial or extracranial lesions that are treated with conformal ( 1 ) or intensity‐modulated radiation therapy ( 2 ) in order to achieve better tumor control and sparing of critical structures and normal tissue. Stereotactic radiotherapy with invasive patient immobilization is mostly used to treat small intracranial lesions with large single or hypofractionated dose.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the setup accuracy of a stereotactic radiotherapy head immobilization mask system using kV on‐board imaging

Ali

Tubbs

Hibbitts

et al. 2010

J Applied Clin Med Phys

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The purpose of this study was to evaluate setup accuracy and quantify random and systematic errors of the BrainLAB stereotactic immobilization mask and localization system using kV on‐board imaging. Nine patients were simulated and set up with the BrainLAB stereotactic head immobilization mask and localizer to be treated for brain lesions using single and hypofractions. Orthogonal pairs of projections were acquired using a kV on‐board imager mounted on a Varian Trilogy machine. The kV projections were then registered with digitally‐reconstructed radiographs (DRR) obtained from treatment planning. Shifts between the kV images and reference DRRs were calculated in the different directions: anterior‐posterior (A‐P), medial‐lateral (R‐L) and superior‐inferior (S‐I). If the shifts were larger than 2 mm in any direction, the patient was reset within the immobilization mask until satisfying setup accuracy based on image guidance has been achieved. Shifts as large as 4.5 mm, 5.0 mm, 8.0 mm in the A‐P, R‐L and S‐I directions, respectively, were measured from image registration of kV projections and DRRs. These shifts represent offsets between the treatment and simulation setup using immobilization mask. The mean offsets of 0.1 mm, 0.7 mm, and −1.6 mm represent systematic errors of the BrainLAB localizer in the A‐P, R‐L and S‐I directions, respectively. The mean of the radial shifts is about 1.7 mm. The standard deviations of the shifts were 2.2 mm, 2.0 mm, and 2.6 mm in A‐P, R‐L and S‐I directions, respectively, which represent random patient setup errors with the BrainLAB mask. The BrainLAB mask provides a noninvasive, practical and flexible immobilization system that keeps the patients in place during treatment. Relying on this system for patient setup might be associated with significant setup errors. Image guidance with the kV on‐board imager provides an independent verification technique to ensure accuracy of patient setup. Since the patient may relax or move during treatment, uncontrolled and undetected setup errors may be produced with patients that are not well‐immobilized. Therefore, the combination of stereotactic immobilization and image guidance achieves more controlled and accurate patient setup within 2 mm in A‐P, R‐L and S‐I directions.PACS numbers: 87.56.‐v, 87.56.Da

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“…[8] More recently, this technique has been adopted for treating tumors outside the brain. [9][10][11][12][13][14][15][16][17][18] Unlike radiosurgery for intracranial targets, stereotactic body radiotherapy (SB-RT) is complicated by less precise target definition and internal organ motion, which requires a margin to ensure coverage of the target volume. Solutions include improving immobilization (i.e.…”

Section: Introductionmentioning

confidence: 99%

A phase I radiation dose escalation of stereotactic body radiotherapy for malignant lung tumors

Cohen¹,

Sharma²,

Yu³

et al. 2010

JBiSE

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Objectives: This Phase I study determines the maximum tolerated dose (MTD) of stereotactic body radiotherapy (SBRT) for lung tumors. Methods: Eligible patients had biopsy proven cancer with a maximum tumor size ≤ 5 cm. Total doses were escalated from 40 to 48, then to 56 Gy, delivered in 4 equal fractions administered 2 to 3 times per week on an IRB approved protocol. SBRT was administered using 5 to 9 fixed beam arrangements with CT localization. Internal target volumes (ITV) were based on breath hold scans or 4D CT simulation. The planning target volume (PTV) was defined as the ITV with a uniform 5 mm expansion. Dose limiting toxicity (DLT) was defined as any grade 3 or higher toxicity using the Radiation Therapy Oncology Group (RTOG) common toxicity criteria (CTC). Results: Between April 2004 and February 2008, 18 patients received the prescribed treatment (40 Gy n = 6, 48 Gy n = 7, 56 Gy n = 5). Seventeen of 18 patients had non-small cell lung cancer (1 with rectal cancer), four of whom were treated for an oligometastasis. The median age of the patients was 68, while the median Karnofsky performance status was 90. The mean tumor size was 2.6 cm (range 0.9 to 4.5 cm). One grade 3 pulmonary event occurred (at 48 Gy dose level) immediately following treatment with the onset of fever and shortness of breath that responded to antibiotics. No other DLTs occurred. Conclusions: SBRT utilizing patient specific target volumes without gating appears safe. The maximum tolerated dose was not reached.

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The effectiveness of an immobilization device in conformal radiotherapy for lung tumor: reduction of respiratory tumor movement and evaluation of the daily setup accuracy

Cited by 203 publications

References 14 publications

Influence of Rotational Setup Error on Tumor Shift in Bony Anatomy Matching Measured with Pulmonary Point Registration in Stereotactic Body Radiotherapy for Early Lung Cancer

Influence of Rotational Setup Error on Tumor Shift in Bony Anatomy Matching Measured with Pulmonary Point Registration in Stereotactic Body Radiotherapy for Early Lung Cancer

Evaluation of the setup accuracy of a stereotactic radiotherapy head immobilization mask system using kV on‐board imaging

A phase I radiation dose escalation of stereotactic body radiotherapy for malignant lung tumors

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