Potential dosimetric benefits of adaptive tumor tracking over the internal target volume concept for stereotactic body radiation therapy of pancreatic cancer

Karava, K.; Ehrbar, Stefanie; Roesch, Johannes; Glatz, S.; Klöck, Stephan; Gückenberger, Matthias; Tanadini‐Lang, Stephanie

doi:10.1186/s13014-017-0906-9

Cited by 12 publications

(7 citation statements)

References 49 publications

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“…If the movement of tumor and organs were ignored during treatment planning, the target dose would be insufficient while the OARs dose would exceed the dose constraint, leading to a decline in the therapeutic effect (21). The AS 20 and VS 20 were the fusion of the AS and VS with 20 phases, respectively, and the contouring of AS 20 and VS 2 covered the motorial range of the AS and VS during the cardiac cycle, which was relatively safe and reliable.…”

Section: Discussionmentioning

confidence: 99%

The margin of internal risk volume on atrial septal and ventricular septal based on electrocardiograph gating 4DCT

Li¹,

Tong²,

Gong³

et al. 2021

Ann Transl Med

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Background: The aim of this study was to quantify the margin of internal risk volume (IRV) on the atrial septum (AS) and ventricular septum (VS) based on electrocardiograph gating (ECG-gating) 4DCT.Methods: Twenty patients were enrolled and received an ECG-gating 4DCT scan performed in breathhold, and CT images were reconstructed at 5% intervals of the cardiac cycle for a total of 20 phases (0-95%).The contouring of the AS and VS were delineated in each phase, and the displacements and margin of the AS and VS were calculated. We fused the total of the AS and VS (0-95% phase), which were recorded as AS 20 and VS 20 . The margins were applied to the AS and VS in every phase and revised according to the cover rate of AS 20 and VS 20 .Results: (I) The margins of the AS and VS according to displacements in the left-right, cranio-caudal, and antero-posterior direction were 3 mm, 3 mm, and 3 mm; and 3 mm, 3 mm, and 2 mm, respectively. (II) The volume of AS 20 was (11.80±3.72) cm 3 , which was 2.9 times larger than the maximum volume of the AS. The volume of VS 20 was (60.45±12.92) cm 3 , which was 1.6 times larger than the maximum volume of the VS. (III)The emendatory margins of the AS and VS in the left-right, cranio-caudal, and antero-posterior direction were 7 mm, 10 mm, and 7 mm; and 5 mm, 3 mm, and 4 mm, respectively. The emendatory margins were added to the AS and VS, and the coverage rates were (95.88±3.29)% and (95.24±2.54)%, respectively. Conclusions:The margin of IRV on the AS and VS could cover the movement of AS and VS induced by heartbeat in the left-right, cranio-caudal, and antero-posterior direction respectively during thoracic radiotherapy.

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Section: Discussionmentioning

confidence: 99%

The margin of internal risk volume on atrial septal and ventricular septal based on electrocardiograph gating 4DCT

Li¹,

Tong²,

Gong³

et al. 2021

Ann Transl Med

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“…The reported improvements in normal tissue irradiation reflect ability to deliver treatment using tracking on a gantry-based linac with reduced PTV size compared to the standard ITV approach. If this technique were to be applied for the treatment of lung and pancreatic cancer, the PTV could be reduced by up to 40% and 17%, respectively [92,93].…”

Section: Advanced Motion Management: Trackingmentioning

confidence: 99%

Adaptive Radiotherapy Enabled by MRI Guidance

et al. 2018

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Adaptive radiotherapy (ART) strategies systematically monitor variations in target and neighbouring structures to inform treatment-plan modification during radiotherapy. This is necessary because a single plan designed before treatment is insufficient to capture the actual dose delivered to the target and adjacent critical structures during the course of radiotherapy. Magnetic resonance imaging (MRI) provides superior soft-tissue image contrast over current standard X-ray-based technologies without additional radiation exposure. With integrated MRI and radiotherapy platforms permitting motion monitoring during treatment delivery, it is possible that adaption can be informed by real-time anatomical imaging. This allows greater treatment accuracy in terms of dose delivered to target with smaller, individualised treatment margins. The use of functional MRI sequences would permit ART to be informed by imaging biomarkers, so allowing both personalised geometric and biological adaption. In this review, we discuss ART solutions enabled by MRI guidance and its potential gains for our patients across tumour types.

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“…Karava et al have recently estimated respiratory-induced pancreatic motion in 12 patients using 4D-CT: mean displacement of 2 mm in antero-posterior (AP), 4.8 mm in inferior-superior (IS) and 1.3 mm in left-right (LR) direction were reported, values that can be hardly managed by the usual target margins. Other authors reported pancreatic movements up to 23 mm in IS, 11 mm in AP and 7 mm in LR directions [13–15].…”

Section: Introductionmentioning

confidence: 99%

Online adaptive magnetic resonance guided radiotherapy for pancreatic cancer: state of the art, pearls and pitfalls

et al. 2019

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Background Different studies have proved in recent years that hypofractionated radiotherapy (RT) improves overall survival of patients affected by locally advanced, unresectable, pancreatic cancer. The clinical management of these patients generally leads to poor results and is considered very challenging, due to different factors, heavily influencing treatment delivery and its outcomes. Firstly, the dose prescribed to the target is limited by the toxicity that the highly radio-sensitive organs at risk (OARs) surrounding the disease can develop. Treatment delivery is also complicated by the significant inter-fractional and intra-fractional variability of therapy volumes, mainly related to the presence of hollow organs and to the breathing cycle. Main body of the abstract The recent introduction of magnetic resonance guided radiotherapy (MRgRT) systems leads to the opportunity to control most of the aforementioned sources of uncertainty influencing RT treatment workflow in pancreatic cancer. MRgRT offers the possibility to accurately identify radiotherapy volumes, thanks to the high soft-tissue contrast provided by the Magnetic Resonance imaging (MRI), and to monitor the tumour and OARs positions during the treatment fraction using a high-temporal cine MRI. However, the main advantage offered by the MRgRT is the possibility to online adapt the RT treatment plan, changing the dose distribution while the patient is still on couch and successfully addressing most of the sources of variability. Short conclusion Aim of this study is to present and discuss the state of the art, the main pitfalls and the innovative opportunities offered by online adaptive MRgRT in pancreatic cancer treatment.

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Potential dosimetric benefits of adaptive tumor tracking over the internal target volume concept for stereotactic body radiation therapy of pancreatic cancer

Cited by 12 publications

References 49 publications

The margin of internal risk volume on atrial septal and ventricular septal based on electrocardiograph gating 4DCT

The margin of internal risk volume on atrial septal and ventricular septal based on electrocardiograph gating 4DCT

Adaptive Radiotherapy Enabled by MRI Guidance

Online adaptive magnetic resonance guided radiotherapy for pancreatic cancer: state of the art, pearls and pitfalls

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