Potentials and Limitations of Guiding Liver Stereotactic Body Radiation Therapy Set-Up on Liver-Implanted Fiducial Markers

Wunderink, Wouter; Romero, Alejandra Méndez; Seppenwoolde, Yvette; Boer, H. de; Levendag, Peter C.; Heijmen, B.

doi:10.1016/j.ijrobp.2009.10.040

Cited by 82 publications

(71 citation statements)

References 16 publications

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“…Many studies on liver motion characterization using markers have been published. 12,16,19 Seppenwoolde et al showed that the tumor position can be accurately predicted using implanted markers considering that there is a real influence of the marker-tumor distance on the set-up accuracy. They also showed that the diaphragm dome was the second best predictor of tumor motion and that it could be used as a surrogate for tumor located close to it.…”

Section: Discussionmentioning

confidence: 99%

“…These can be used during the patient's setup and for the tumor motion verification as they are implanted inside or close to the target. 16 Recent report evaluated the geometric accuracy of the surrogate-based gated VMAT with a respiratory phantom and also on real patients cases including liver tumors. 17 Li et al showed in a phantom study a high geometric accuracy (average error of 0.8 mm in the CC direction) when no targetsurrogate relation changes occurred during the treatment.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of reproducibility of tumor repositioning during multiple breathing cycles for liver stereotactic body radiotherapy treatment

Bedos

Riou

Aillères

et al. 2017

Reports of Practical Oncology & Radiotherapy

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a b s t r a c tAim: To evaluate the tumor repositioning during gated volumetric modulated arc therapy (VMAT) for liver stereotactic body radiotherapy(SBRT) treatment using implanted fiducial markers and intrafraction kilovoltage (kV) images acquired during dose delivery. Materials and methods:Since 2012, 47 liver cancer patients with implanted fiducial markers were treated using the gated VMAT technique with a Varian Truebeam STx linear accelerator.The fiducial markers were implanted inside or close to the tumor target before treatment simulation. They were defined at the maximum inhalation and exhalation phases on a 4-dimensionnal computed tomography (4DCT) acquisition. During the treatment, kV images were acquired just before the beam-on at each breathing cycle at maximum exhalation and inhalation phases to verify the fiducial markers positions. For the five first fractions of treatment in the first ten consecutive patients, a total of 2705 intrafraction kV images were retrospectively analyzed to assess the differences between expected and actual positions of the fiducial markers along the cranio-caudal (CC) direction during the exhalation phase. Results:The mean absolute intrafractional fiducial marker deviation along the CC direction was 1.0 mm at the maximum exhalation phase. In 99%, 95% and 90% cases, the fiducial marker deviations were ≤4.5 mm, 2.8 mm and 2.2 mm, respectively. Conclusion:Intrafraction kV images allowed us to ensure the consistency of tumor repositioning during treatment. In 99% cases, the fiducial marker deviations were ≤4.5 mm corresponding to our 5 mm treatment margin. This margin seems to be well-adapted to the gated VMAT SBRT treatment in liver disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of reproducibility of tumor repositioning during multiple breathing cycles for liver stereotactic body radiotherapy treatment

Bedos

Riou

Aillères

et al. 2017

Reports of Practical Oncology & Radiotherapy

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“…Details about this procedure have been reported earlier. 5,[11][12][13] From 2011, only one large contrast enhanced planning CT in the venous phase was acquired. The tumor delineations have always been reviewed by an experienced radiologist.…”

Section: Treatment Preparation and Deliverymentioning

confidence: 99%

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Romero

Keskin-Cambay

et al. 2017

Reports of Practical Oncology & Radiotherapy

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Metastases LiverStereotactic body radiation therapy a b s t r a c t Aim: To investigate whether the impact of dose escalation in our patient population represented an improvement in local control without increasing treatment related toxicity. Materials and methods:A cohort of consecutive patients with colorectal liver metastases treated with stereotactic body radiation therapy (SBRT) between December 2002 and December 2013 were eligible for this study. Inclusion criteria were a Karnofsky performance status ≥80% and, according to the multidisciplinary tumor board, ineligibility for surgery or radiofrequency ablation. Exclusion criteria were a lesion size >6 cm, more than 3 metastases, and treatment delivered with other fractionation scheme than 3 times 12.5 Gy or 16.75 Gy prescribed at the 65-67% isodose. To analyze local control, CT or MRI scans were acquired during follow-up. Toxicity was scored using the Common Toxicity Criteria Adverse Events v4.0.Results: A total of 40 patients with 55 colorectal liver metastases were included in this study.We delivered 37.5 Gy to 32 lesions, and 50.25 Gy to 23 lesions. Median follow-up was 26 and 25 months for these two groups. Local control at 2 and 3 years was 74 and 66% in the low dose group while 90 and 81% was reached in the high dose group. No significant difference in local control between the two dose fractionation schemes could be found. Grade 3 toxicity was limited and was not increased in the high dose group.Conclusions: SBRT for colorectal liver metastases offers a high chance of local control at long term. High irradiation doses may contribute to enhance this effect without increasing toxicity.

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“…fiducial markers are implanted in proximity of the target lesion and can be visualized by computed tomography or x-ray images as a tumor surrogate to assure its correct position during treatment. New technologies such as gating and tracking of target lesions depend on the breathing phase and are correlated with the dose application [43][44][45].…”

Section: Discussionmentioning

confidence: 99%

Single-dose radiosurgical treatment for hepatic metastases – Therapeutic outcome of 178 treated lesions from a single institution

Habermehl¹,

Herfarth²,

Bermejo³

et al. 2013

Z Gastroenterol

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Background: Local ablative therapies such as stereotactically guided single-dose radiotherapy or helical intensitymodulated radiotherapy (tomotherapy) with high single-doses are successfully applied in many centers in patients with liver metastasis not suitable for surgical resection. This study presents results from more than 10 years of clinical experience and evaluates long-term outcome and efficacy of this therapeutic approach.

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Potentials and Limitations of Guiding Liver Stereotactic Body Radiation Therapy Set-Up on Liver-Implanted Fiducial Markers

Cited by 82 publications

References 16 publications

Evaluation of reproducibility of tumor repositioning during multiple breathing cycles for liver stereotactic body radiotherapy treatment

Evaluation of reproducibility of tumor repositioning during multiple breathing cycles for liver stereotactic body radiotherapy treatment

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Single-dose radiosurgical treatment for hepatic metastases – Therapeutic outcome of 178 treated lesions from a single institution

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