Quantification of Esophageal Tumor Motion and Investigation of Different Image-Guided Correction Strategies

Voncken, Francine E.M.; Nakhaee, S.; Stam, Barbara; Wiersema, Lisa M.; Vollenbrock, Sophie E; Dieren, Jolanda M. van; Leerdam, Monique E. van; Sonke, Jan‐Jakob; Aleman, Berthe M.P.; Remeijer, P.

doi:10.1016/j.prro.2019.11.012

Cited by 18 publications

(26 citation statements)

References 28 publications

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“…Image-guided radiotherapy (IGRT) with cone-beam computed tomography (CBCT) is commonly used in practice for patient set-up verification in esophageal cancer treatment. But inter and intra fraction tumor variations are still a dominant uncertainty in esophageal cancer radiotherapy, such as target deformation and respiration motion, which are generally not possible to be solved by conventional IGRT with CBCT (3).…”

Section: Introductionmentioning

confidence: 99%

In-Air Electron Streaming Effect for Esophageal Cancer Radiotherapy With a 1.5 T Perpendicular Magnetic Field: A Treatment Planning Study

et al. 2020

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PurposeTo investigate the in-air out-of-field electron streaming effect (ESE) for esophageal cancer radiotherapy in the presence of 1.5 T perpendicular magnetic field.MethodsTen esophageal cancer patients treated with conventional Linac were retrospectively enrolled into a cohort of this study, with the prescription of 4,400 cGy/20 fx. All cases received IMRT replanning using Elekta Unity MR-Linac specified Monaco system, denoted as primary plan. To visualize the in-air dose outside the body in Monaco system, an auxiliary structure was created by extending the external structure. For each case, another comparable plan with no magnetic field was created using the same planning parameters. The plan was also recalculated by placing a bolus upon the neck and chin area to investigate its shielding effect for ESE. Dosimetric evaluations of the out-of-field neck and chin skin area and statistical analysis for these plans were then performed.ResultsOut-of-field ESE was also observed in esophageal cancer treatment planning under 1.5 T magnetic field, while totally absent for plans with no magnetic field. On average, the maximum dose to the neck and chin skin area of the primary plan (657.92 ± 69.07 cGy) was higher than that of plan with no magnetic field (281.78 ± 36.59 cGy, p = 0.005) and plan with bolus (398.43 ± 69.19 cGy, p = 0.007). DVH metrics D1cc (the minimum dose to 1 cc volume) of the neck and chin skin for primary plan was 382.06 ± 44.14 cGy, which can be reduced to 212.42 ± 23.65 cGy by using the 1 cm bolus (with p = 0.005), even lower than the plan without magnetic field (214.45 ± 23.82, p = 0.005). No statistically significant difference of the neck and chin skin dose between the plan with bolus and plan with no magnetic field was observed (all with p > 0.05).ConclusionFor MRI guided esophageal cancer radiotherapy, a relatively high out-of-field neck and chin skin doses will be introduced by ESE in the presence of magnetic field. It is therefore recommended to take this into account during the planning phase. Adding bolus could effectively reduce the ESE dose contributions, achieve the shielding effect almost equivalent to the scenario with no magnetic field. Further explorations of measurement verifications for the ESE dose distributions are required.

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Section: Introductionmentioning

confidence: 99%

In-Air Electron Streaming Effect for Esophageal Cancer Radiotherapy With a 1.5 T Perpendicular Magnetic Field: A Treatment Planning Study

et al. 2020

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“…Previously published studies on CTV-to-PTV margins for esophageal cancer -based on the relative motion statistics of implanted gold markers in combination with the 'van Herk'-recipe -reported comparable anistropic margins for the three main directions. Substantial marker position variability with respect to the bony anatomy has been reported by Voncken et al yielding PTV margins of 10, 13 and 7 mm in LR, CC and AP direction, respectively 15 . Similarly, Jin et al reported that a margin of 9 mm in LR direction, 12 mm in CC direction and 7 mm in AP direction should provide sufficient target coverage 13 .…”

Section: Discussionmentioning

confidence: 81%

“…Many studies have investigated these geometrical uncertainties in order to quantify the associated CTV-to-Planning Target Volume (PTV) margins with the use of repetitive CT, CBCT or Magnetic Resonance Imaging (MRI) over the course of treatment 6,7,[9][10][11][12][13][14][15][16] . Of particular interest are the recent studies that reported on the inter-and intrafraction displacement on CBCTs of fiducial markers that were endoscopically placed at some anchor points in the tumor [13][14][15] . Here, the marker movements were used as a surrogate for the gross tumor volume (GTV) and CTV displacements as generally the 3D anatomy of the CTV cannot be adequately segmented on the CBCT.…”

Section: Introductionmentioning

confidence: 99%

CTV-to-PTV margin assessment for esophageal cancer radiotherapy based on an accumulated dose analysis

Boekhoff

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Borggreve

et al. 2021

Radiotherapy and Oncology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Moreover, respiratory gating can mitigate the effect of respiratory motion and reduce the required PTV (42). On conventional linear accelerators, respiratory gating is performed using external surrogates, but the correlation between such surrogates and tumor motion can vary substantially (43). As such, image guidance is of utmost importance for accurate respiratory gating to avoid a geographical miss.…”

Section: Dealing With Intrafraction Tumor Motionmentioning

confidence: 99%

Review of MR-Guided Radiotherapy for Esophageal Cancer

et al. 2021

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In this review, we outline the potential benefits and the future role of MRI and MR-guided radiotherapy (MRgRT) in the management of esophageal cancer. Although not currently used in most clinical practice settings, MRI is a useful non-invasive imaging modality that provides excellent soft tissue contrast and the ability to visualize cancer physiology. Chemoradiation therapy with or without surgery is essential for the management of locally advanced esophageal cancer. MRI can help stage esophageal cancer, delineate the gross tumor volume (GTV), and assess the response to chemoradiotherapy. Integrated MRgRT systems can help overcome the challenge of esophageal motion due to respiratory motion by using real-time imaging and tumor tracking with respiratory gating. With daily on-table MRI, shifts in tumor position and tumor regression can be taken into account for online-adaptation. The combination of accurate GTV visualization, respiratory gating, and online adaptive planning, allows for tighter treatment volumes and improved sparing of the surrounding normal organs. This could lead to a reduction in radiotherapy induced cardiac toxicity, pneumonitis and post-operative complications. Tumor physiology as seen on diffusion weighted imaging or dynamic contrast enhancement can help individualize treatments based on the response to chemoradiotherapy. Patients with a complete response on MRI can be considered for organ preservation while patients with no response can be offered an earlier resection. In patients with a partial response to chemoradiotherapy, areas of residual cancer can be targeted for dose escalation. The tighter and more accurate targeting enabled with MRgRT may enable hypofractionated treatment schedules.

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Quantification of Esophageal Tumor Motion and Investigation of Different Image-Guided Correction Strategies

Cited by 18 publications

References 28 publications

In-Air Electron Streaming Effect for Esophageal Cancer Radiotherapy With a 1.5 T Perpendicular Magnetic Field: A Treatment Planning Study

In-Air Electron Streaming Effect for Esophageal Cancer Radiotherapy With a 1.5 T Perpendicular Magnetic Field: A Treatment Planning Study

CTV-to-PTV margin assessment for esophageal cancer radiotherapy based on an accumulated dose analysis

Review of MR-Guided Radiotherapy for Esophageal Cancer

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