Respiration-induced movement of the upper abdominal organs: a pitfall for the three-dimensional conformal radiation treatment of pancreatic cancer

Bussels, Barbara; Goethals, Laurence; Féron, Michel; Bielen, Didier; Dymarkowski, Steven; Suetens, Paul; Haustermans, Karin

doi:10.1016/s0167-8140(03)00133-6

Cited by 190 publications

(133 citation statements)

References 17 publications

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“…When considering dosimetric differences between RA and IMRT, it is also important to address motion management for abdominal tumors, as craniocaudal pancreatic motion of up to 25 mm has been reported [6,12]. Mean pancreatic motion on 4DCT of our patients was only 9 mm, however, with extremes of up to 15 mm.…”

Section: F-imrtmentioning

confidence: 76%

Volumetric Modulated Arc Therapy for Advanced Pancreatic Cancer

et al. 2010

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Background: Intensity-modulated radiotherapy (IMRT) allows for improved sparing of organs at risk (OARs) in advanced pancreatic cancer. A planning study evaluated if volumetric modulated arc therapy (RapidArc™ [RA]) could be used as an alternative to IMRT in such cases. Patients and Methods: In ten patients, five-field IMRT (5f-IMRT) plans with fixed gantry positions were compared to RA plans using similar constraints for planning target volume (PTV) and OARs. PTV coverage, conformity indices (CI), and OAR doses were compared. One patient was treated using RA and calculated dose distributions were measured in coronal planes in a solid-water phantom. Results: RA plans showed superior mean CI of 1.09 ± 0.02 (± 1 SD [standard deviation]) versus 1.20 ± 0.10 in 5f-IMRT (p = 0.003). Both techniques achieved similar sparing of the right kidney, but RA significantly reduced left kidney doses with V 15 of 7.2% ± 5.3% and 15.9% ± 11.1%, respectively; p = 0.02. RA modestly decreased mean doses to liver (13.8 vs. 15.1 Gy; p = 0.003), stomach (16.7 vs. 17.9 Gy; p = 0.017), small bowel (19.8 vs. 22.1 Gy; p < 0.001), and duodenum (38.8 vs. 41.9 Gy; p = 0.004). Film dosimetry revealed excellent agreement between calculated and measured dose distributions. The delivery time for RA was < 3 min. Conclusion: RA planning achieved superior CI for pancreatic tumors compared to 5f-IMRT, and modestly reduced OAR doses. Fast treatment delivery using RA may decrease the risk of intrafractional organ motion. Ergebnisse: RA-Pläne zeigten einen günstigeren CI von 1,09 ± 0,02 (± 1 SD [Standardabweichung]) gegenüber 1,20 ± 0,10 bei 5f-IMRT (p = 0,003). Mit beiden Techniken gelang eine zufriedenstellende Dosisreduktion der rechten Niere, mittels RA konnten jedoch die V 15 der linken Niere signifikant reduziert werden (7,2% ± 5,3% vs. 15,9% ± 11,1% bei IMRT; p = 0,02). Geringer zeigte sich die Reduktion der mittleren Dosis der Leber (13,8 vs. 15,1 Gy; p = 0,003), des Magens (16,7 vs. 17,9 Gy; p = 0,017), des Dünndarms (19,8 vs. 22,1 Gy; p < 0,001) und des Duodenums (38,8 vs. 41,9 Gy; p = 0,004). Filmdosimetrische Überprüfungen zeigten hervorragende Übereinstimmungen bezüglich kalkulierter und tatsächlicher Dosisverteilung. Die Gesamtbestrahlungszeit betrug < 3 min. Schlussfolgerung: Mittels RA-Planung lässt sich im Vergleich zur 5f-IMRT sowohl ein günstigerer CI als auch moderate Dosisreduktion in den OAR erreichen. Durch die rasche Dosisapplikation vermindert sich das Risiko intrafraktionärer Bewegung der OAR.Schlüsselwörter: Pankreaskarzinom · "Volumetric modulated arc therapy" · Intensitätsmodulierte Radiotherapie · Planungsstudie · Risikoorgane

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Section: F-imrtmentioning

confidence: 76%

Volumetric Modulated Arc Therapy for Advanced Pancreatic Cancer

et al. 2010

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“…Several studies have demonstrated significant effects of the above‐listed immobilization devices in intrafraction motion mitigation, 21 , 23 , 29 , 30 the unconstrained condition was therefore not included in the study, since our goal was to quantify the level of immobilization in the abdomen–pelvis region as a function of patient setup position and selected immobilization devices. It should be noted that the condition “vacuum cushion” cannot be considered an unconstrained condition, since the MR scan was performed with the body matrix coil slightly tightened to the patient thorax and back (supine and prone position, respectively), mimicking the effects of a mild restraining belt.…”

Section: Methodsmentioning

confidence: 99%

MRI quantification of pancreas motion as a function of patient setup for particle therapy —a preliminary study

Fontana

Riboldi

Gianoli

et al. 2016

J Applied Clin Med Phys

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Particle therapy (PT) has shown positive therapeutic results in local control of locally advanced pancreatic lesions. PT effectiveness is highly influenced by target localization accuracy both in space, since the pancreas is located in proximity to radiosensitive vital organs, and in time as it is subject to substantial breathing‐related motion. The purpose of this preliminary study was to quantify pancreas range of motion under typical PT treatment conditions. Three common immobilization devices (vacuum cushion, thermoplastic mask, and compressor belt) were evaluated on five male patients in prone and supine positions. Retrospective four‐dimensional magnetic resonance imaging data were reconstructed for each condition and the pancreas was manually segmented on each of six breathing phases. A k‐means algorithm was then applied on the manually segmented map in order to obtain clusters representative of the three pancreas segments: head, body, and tail. Centers of mass (COM) for the pancreas and its segments were computed, as well as their displacements with respect to a reference breathing phase (beginning exhalation). The median three‐dimensional COM displacements were in the range of 3 mm. Latero–lateral and superior–inferior directions had a higher range of motion than the anterior–posterior direction. Motion analysis of the pancreas segments showed slightly lower COM displacements for the head cluster compared to the tail cluster, especially in prone position. Statistically significant differences were found within patients among the investigated setups. Hence a patient‐specific approach, rather than a general strategy, is suggested to define the optimal treatment setup in the frame of a millimeter positioning accuracy.PACS number(s): 87.55.‐x, 87.57.nm, 87.61

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“…Organ motion due to breathing during treatment delivery can result in an organ at risk (OAR) entering the treatment beam and subsequently exceed the tolerance dose while the target may move outside of the treatment beam, restricting the dose it receives to less than the intended prescription dose. Various CT and MR studies report kidney motion due to shallow respiration to occur in a complex pattern with the largest movement in the superior–inferior direction, an average of 6.7–19.0 mm 1 , 2 , 3 , 4 , 5 , 6 , 7 . In order to limit OAR and target motion, a variety of immobilization techniques are available and explained in detail by the report of AAPM Task Group 76, which contains the recommendation that in the cases where a

\geq 5 mm

range of motion is observed, respiratory management techniques should be employed 1 , 2 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of kidney motion and target localization in abdominal SBRT patients

Sonier

Chu

Lalani

et al. 2016

J Applied Clin Med Phys

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The purpose of this study was to evaluate bilateral kidney and target translational/rotational intrafraction motion during stereotactic body radiation therapy treatment delivery of primary renal cell carcinoma and oligometastatic adrenal lesions for patients immobilized in the Elekta BodyFIX system. Bilateral kidney motion was assessed at midplane for 30 patients immobilized in a full‐body dual‐vacuum‐cushion system with two patients immobilized via abdominal compression. Intrafraction motion was assessed for 15 patients using kilovoltage cone‐beam computed tomography (kV‐CBCT) datasets (normaln=151) correlated to the planning CT. Patient positioning was corrected for translational and rotational misalignments using a robotic couch in six degrees of freedom if setup errors exceeded 1 mm and 1°. Absolute bilateral kidney motion between inhale and exhale 4D CT imaging phases for left–right (LR), superior–inferior (SI), and anterior–posterior (AP) directions was 1.51±1.00.15emmm,8.10±4.33.15emmm, and 3.08±2.11.15emmm, respectively. Residual setup error determined across CBCT type (pretreatment, intrafraction, and post‐treatment) for x (LR), y (SI), and z (AP) translations was 0.63±0.74.15emmm,1.08±1.38.15emmm, and 0.70±1.00.15emmm; while for x (pitch), y (roll), and z (yaw) rotations was 0.24±0.39°,0.19±0.34°, and 0.26±0.43°, respectively. Targets were localized to within 2.1 mm and 0.8° 95% of the time. The frequency of misalignments in the y direction was significant (p<0.05) when compared to the x and z directions with no significant difference in translations between IMRT and VMAT. This technique is robust using BodyFIX for patient immobilization and reproducible localization of kidney and adrenal targets and daily CBCT image guidance for correction of positional errors to maintain treatment accuracy.PACS number(s): 87.55.‐x, 87.56.‐v, 87.56.Da

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Respiration-induced movement of the upper abdominal organs: a pitfall for the three-dimensional conformal radiation treatment of pancreatic cancer

Cited by 190 publications

References 17 publications

Volumetric Modulated Arc Therapy for Advanced Pancreatic Cancer

Volumetric Modulated Arc Therapy for Advanced Pancreatic Cancer

MRI quantification of pancreas motion as a function of patient setup for particle therapy —a preliminary study

Evaluation of kidney motion and target localization in abdominal SBRT patients

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