Impact of lung tumor motion on dose delivered to organ at risk in lung stereotactic body radiation therapy

Savanović, Milovan; Štrbac, Bojan; Jaroš, Dražan; Ćazić, Dejan; Foulquier, Jean Noel

doi:10.1007/s13566-020-00439-7

J Radiat Oncol

2020

DOI: 10.1007/s13566-020-00439-7

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Impact of lung tumor motion on dose delivered to organ at risk in lung stereotactic body radiation therapy

Milovan Savanović

Bojan Štrbac

Dražan Jaroš³

et al.

Abstract: Purpose To evaluate the amplitude of lung tumor motion and impact of tumor motion on dose delivered to the organs at risk (OARs) during lung stereotactic body radiation therapy (SBRT).Materials and methods This study included 55 patients (30 males and 25 females) with lung cancer who had a small gross tumor volume (GTV). SBRT lung cancer patients were treated with a prescribed dose of 60 Gy in 4 to 8 fractions. Radiotherapy plans were planned in Pinnacle 9.10 with two partial dynamic conformal arcs (DCAs) for … Show more

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Cited by 3 publications

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“…[3] The treatment of lung cancer with high doses can be impacted by tumor motion and proximity to the organ at risk. [4][5][6][7] Various techniques were developed to take into consideration tumor motion during treatment delivery to accurately target the moving tumor and to spare healthy tissues. [8][9][10] The abdominal compression technique is used to reduce the breathing amplitude, reducing the amplitude of the tumor motion throughout the respiratory cycle.…”

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confidence: 99%

Comparison of Phase-Gated and Amplitude-Gated Dose Delivery to a Moving Target using Gafchromic EBT3 Film

Savanović

Jaroš²,

Foulquier

2021

Journal of Medical Physics

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IntroductIonLung stereotactic body radiation therapy (SBRT) is used for the treatment of early-stage nonsmall cell lung cancer and metastatic lung tumors. [1,2] SBRT treatments are delivered in a hypofractionation mode, with high doses in a few fractions (from 3 to 8 fractions), depending on tumor localization (central or peripheral tumors). [3] The treatment of lung cancer with high doses can be impacted by tumor motion and proximity to the organ at risk. [4][5][6][7] Various techniques were developed to take into consideration tumor motion during treatment delivery to accurately target the moving tumor and to spare healthy tissues. [8][9][10] The abdominal compression technique is used to reduce the breathing amplitude, reducing the amplitude of the tumor motion throughout the respiratory cycle. [8] Radiation during a certain phase of the respiratory cycle can be performed using respiratory gating radiation therapy (RGRT). [9] Real-time tumor tracking allows for tumor irradiation throughout the respiratory cycle. [10] RGRT does not require controlled breathing or breath hold during simulation and dose delivery. There are three types of gating: phase gating, amplitude gating, and breath-hold gating techniques. With phase gating, the treatment is delivered during a certain phase of the respiratory cycle. With amplitude gating, the treatment is delivered when a chosen threshold of the breathing amplitude is reached, which is generally during the Introduction: This study compared phase-gated and amplitude-gated dose deliveries to the moving gross tumor volume (GTV) in lung stereotactic body radiation therapy (SBRT) using Gafchromic External Beam Therapy (EBT3) dosimetry film. Materials and Methods: Eighty treatment plans using two techniques (40 phase gated and 40 amplitude gated) were delivered using dynamic conformal arc therapy (DCAT). The GTV motion, breathing amplitude, and period were taken from 40 lung SBRT patients who performed regular breathing. These parameters were re-simulated using a modified Varian breathing mini phantom. The dosimetric accuracy of the phase-and amplitude-gated treatment plans was analyzed using Gafchromic EBT3 dosimetry film. The treatment delivery efficacy was analyzed for gantry rotation, number of monitor unit (MU), and target position per triggering window. The time required to deliver the phase-and amplitude-gated treatment techniques was also evaluated. Results: The mean dose (range) per fraction was 16.11 ± 0.91 Gy (13.04-17.50 Gy) versus 16.26 ± 0.83 Gy (13.82-17.99 Gy) (P < 0.0001) for phase-and amplitude-gated delivery. The greater difference in the gamma passing rate was 1.2% ±0.4% in the amplitude-gated compared to the phase gated. The gantry rotation per triggering time (tt) was 2° ±1° (1.2°-3°) versus 5° ±1° (3°-6°) (P < 0.0001) and MU per tt was 10 ± 3 MU (6-13 MU) versus 24 ± 7 MU (12-32 MU) (P < 0.0001), for phase-versus amplitude-gated techniques. A 90 beam interruption in the phase-gated technique impacted the treatment delivery efficacy, increasing the treatmen...

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confidence: 99%

Comparison of Phase-Gated and Amplitude-Gated Dose Delivery to a Moving Target using Gafchromic EBT3 Film

Savanović

Jaroš²,

Foulquier

2021

Journal of Medical Physics

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CArdiac and REspiratory adaptive Computed Tomography (CARE-CT): a proof-of-concept digital phantom study

et al. 2022

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Current respiratory 4DCT imaging for high-dose rate thoracic radiotherapy treatments are negatively affected by the complex interaction of cardiac and respiratory motion. We propose an imaging method to reduce artifacts caused by thoracic motion, CArdiac and REspiratory adaptive CT (CARE-CT), that monitors respiratory motion and ECG signals in real-time, triggering CT acquisition during combined cardiac and respiratory bins. Using a digital phantom, conventional 4DCT and CARE-CT acquisitions for nineteen patient-measured physiological traces were simulated. Ten respiratory bins were acquired for conventional 4DCT scans and ten respiratory bins during cardiac diastole were acquired for CARE-CT scans. Image artifacts were quantified for 10 common thoracic organs at risk (OAR) substructures using the differential normalized cross correlation between axial slices (ΔNCC), mean squared error (MSE) and sensitivity. For all images, on average, CARE-CT improved the ΔNCC for 18/19 and the MSE and sensitivity for all patient traces. The ΔNCC was reduced for all cardiac OARs (mean reduction 21%). The MSE was reduced for all OARs (mean reduction 36%). In the digital phantom study, the average scan time was increased from 1.8 ± 0.4 min to 7.5 ± 2.2 min with a reduction in average beam on time from 98 ± 28 s to 45 s using CARE-CT compared to conventional 4DCT. The proof-of-concept study indicates the potential for CARE-CT to image the thorax in real-time during the cardiac and respiratory cycle simultaneously, to reduce image artifacts for common thoracic OARs.

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Absolute dose measurements for lung gated delivery stereotactic body radiation therapy

Savanović

Jaroš

Chauchat

et al. 2021

Radiation Physics and Chemistry

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Impact of lung tumor motion on dose delivered to organ at risk in lung stereotactic body radiation therapy

Cited by 3 publications

References 46 publications

Comparison of Phase-Gated and Amplitude-Gated Dose Delivery to a Moving Target using Gafchromic EBT3 Film

Comparison of Phase-Gated and Amplitude-Gated Dose Delivery to a Moving Target using Gafchromic EBT3 Film

CArdiac and REspiratory adaptive Computed Tomography (CARE-CT): a proof-of-concept digital phantom study

Absolute dose measurements for lung gated delivery stereotactic body radiation therapy

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