Determination of planning target volume for whole stomach irradiation using daily megavoltage computed tomographic images

Johnson, Matthew E.; Pereira, Gisèle; Naqa, Issam El; Goddu, S; Al-Lozi, Rawan; Apte, Aditya; Mansur, David B.

doi:10.1016/j.prro.2012.02.001

Cited by 13 publications

(22 citation statements)

References 12 publications

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“…3,4,14 More recently, researchers have shown that the use of a breath-hold technique and daily image guidance reduces stomach motion and improves setup accuracy in patients treated for gastric cancer. With this approach, PTV margins of 0.5 to 1 cm were shown to be sufficient.…”

Section: Discussionmentioning

confidence: 99%

“…IMRT plans were generated with the Pinnacle treatment planning system (Pinnacle, 3 Philips Medical Systems, Fitchburg, WI) using 5 to 7 coplanar 6-MV photon beams. In all plans, >95% of the PTV was covered by the prescription dose.…”

Section: Methodsmentioning

confidence: 99%

“…9–12 One approach is to add an adequate margin to the clinical target volume (CTV), so the involved site is encompassed within the treatment volume throughout the normal respiratory cycle 8,13 ; however, the resulting large planning target volume (PTV) may cause the delivery of excess dose to surrounding normal structures. 3,14 Techniques that reduce the effect of organ motion during RT include the use of external respiratory restraining devices, 9 gating, 15–17 and breath-hold. 18 For example, Wagman et al found that the PTV margin could be reduced from 2 to 1 cm if patients held their breath, rather than breathing freely, during RT for liver tumors.…”

Section: Introductionmentioning

confidence: 99%

“…3,19 In the treatment of gastric MALT lymphoma, CT-IGRT provides information about the shape and position of the stomach before each fraction, so patient positioning can be adjusted appropriately. Cone beam CT (CBCT) is the most widely available type of CT-IGRT unit; however, CT-on-Rails (CTOR) produces higher quality images for intra-abdominal soft tissue organs.…”

Section: Introductionmentioning

confidence: 99%

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Daily CT guidance improves target coverage during definitive radiation therapy for gastric MALT lymphoma

Milgrom

Dabaja

et al. 2017

Practical Radiation Oncology

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Purpose Radiation therapy (RT) for gastric mucosa–associated lymphoid tissue (MALT) lymphoma is challenging because of variation in the stomach’s position, size, and shape. We investigated the interfractional changes in stomach location, consequent dosimetric effects, and impact of daily computed tomography image guidance RT (CT-IGRT). Methods and materials Twelve patients treated for gastric MALT lymphoma with intensity modulated radiation therapy, using a breath-hold technique and restriction of oral intake, were studied retrospectively. The planning target volume (PTV) comprised a 0.5 to 1.0 cm expansion of the stomach. The prescription dose was 30 Gy in 15 to 20 fractions. CT-IGRT was performed daily using CT-on-Rails. Dosimetry was calculated on 229 daily CT images after bony versus CT-based soft tissue alignment, and doses delivered to the target and adjacent structures were compared with the treatment plan. Target coverage was expressed as the percent of the clinical target volume (CTV) and PTV receiving ≥95% of the prescribed dose (V95%). Results The average change in stomach volume was −12.4% (range, −47.6% to 38.6%). The average shift required for target coverage was 1.0 cm (maximum, 2.2 cm). With CT-based alignment to the stomach, the average V95% was 98.5% for CTV and 94.9% for PTV; with bony alignment, these values were 94.5% and 90.4%, respectively (P < .01 for CTV and PTV). With bony alignment, the PTV V95% was ≤90% in 4 patients (33%) over the course of treatment and was as low as 72.5% for 1 fraction. The kidney position varied with respect to the stomach and bony anatomy. Consequently, the dose to the left kidney was higher based on daily CT scans than on planning scans. Dose to other organs at risk did not vary significantly. Conclusions Substantial interfractional variation in stomach volume was observed, despite treatment with breath-hold and restriction of oral intake. Daily CT-IGRT improved target coverage, enabling excellent coverage despite the use of small PTV margins.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Daily CT guidance improves target coverage during definitive radiation therapy for gastric MALT lymphoma

Milgrom

Dabaja

et al. 2017

Practical Radiation Oncology

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“…Megavoltage CT (MVCT) is used in different tumour sites as a daily IGRT technique to quantify systematic and random errors. 63 Johnson et al 64 used daily MVCT to analyse the interfraction variation of the stomach position in gastric lymphoma. Aggarwal et al 65 assessed the use of tomotherapy with MVCT to estimate the internal target volume of gastric tumours and showed that the target changes widely during the course of radiation treatment, and severe target displacements were observed.…”

Section: Interfractional Motionmentioning

confidence: 99%

Chemoradiation for gastric cancer: controversies, updates and novel techniques

Fan

Zhang

2015

BJR

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The INT0116 trial established the role of adjuvant chemoradiation (CRT) in the multidisciplinary approach to the management of locally advanced gastric cancer. However, whether adjuvant CRT is indispensable for patients undergoing D2 dissection remains undefined. The adjuvant chemoradiation therapy in stomach cancer (ARTIST) trial, which was designed to compare adjuvant chemotherapy to CRT, failed to demonstrate differences in disease-free and overall survival in the whole study group; however, subgroup analysis indicated that patients with lymph node metastasis may benefit from additional radiation. A follow-up ARTIST II trial is currently under way. The efficacy of adjuvant CRT remains controversial because of variation among studies in the inclusion criteria and treatment delivery methods; however, the identification of patients who would benefit from CRT is critical. Advanced radiotherapy techniques such as intensity-modulated radiotherapy protect normal tissues via motion management and decreased radiation-induced toxicity and contribute to plan optimization. Further studies integrating clinical and molecular factors as well as neoadjuvant CRT are warranted.Gastric cancer is one of the most frequent malignancies. It is the fifth most common malignancy and the third leading cause of cancer-related death in the world.

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Four-dimensional cone-beam computed tomography-guided radiotherapy for gastric lymphoma

et al. 2017

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Determination of planning target volume for whole stomach irradiation using daily megavoltage computed tomographic images

Cited by 13 publications

References 12 publications

Daily CT guidance improves target coverage during definitive radiation therapy for gastric MALT lymphoma

Daily CT guidance improves target coverage during definitive radiation therapy for gastric MALT lymphoma

Chemoradiation for gastric cancer: controversies, updates and novel techniques

Four-dimensional cone-beam computed tomography-guided radiotherapy for gastric lymphoma

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