Geometric Reproducibility of Fiducial Markers and Efficacy of a Patient-Specific Margin Design Using Deep Inspiration Breath Hold for Stereotactic Body Radiation Therapy for Pancreatic Cancer.
Geometric Reproducibility of Fiducial Markers and Efficacy of a Patient-Specific Margin Design Using Deep Inspiration Breath Hold for Stereotactic Body Radiation Therapy for Pancreatic Cancer.
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基于深度吸气屏气的胰腺癌立体定向放射治疗中基准标记物的几何可重复性和患者特异性边缘设计的疗效。
DOI：
10.1016/j.adro.2021.100655
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发表时间：
2021-03
影响因子：
2.3
通讯作者：
Narang A
中科院分区：
文献类型：
--
作者：
Han-Oh S;Hill C;Kang-Hsin Wang K;Ding K;Wright JL;Alcorn S;Meyer J;Herman J;Narang A
在接受立体定向体部放射治疗（SBRT）治疗胰腺癌的患者中，深吸气屏气之间肿瘤定位的可重复性尚不清楚。我们在模拟和治疗时用基准点描述了这种变化，并研究了患者特异性屏气（PSBH）边缘是否有助于解释治疗时的分次内变化。我们分析了20例连续的胰腺癌患者，他们接受了深吸气屏气SBRT。在模拟时，在对比度增强计划计算机断层扫描（CT）扫描后立即采集3次额外的屏气扫描，并用于量化模拟基准位置（Sim_Varavg和Sim_Varmax）的平均和最大变化，以及设计包含PSBH裕度的内部靶体积（ITV）。治疗时，每例患者每次平均采集5次屏气锥形束CT（CBCT）扫描，以量化治疗基准位置的平均和最大变化（Tx_Varavg和Tx_Varmax）。使用CBCT扫描评估了大体肿瘤体积（GTV）与ITV的各种计划靶体积（PTV）边缘，目标是在治疗时覆盖>95%的基准点。左右（LR）方向的Sim_Varavg和Sim_Varmax分别为0.9 ± 0.5 mm和1.5 ± 0.8 mm，前后（AP）方向的Sim_Varavg和Sim_Varmax分别为0.9 ± 0.4 mm和1.4 ± 0.4 mm，上下（SI）方向的Sim_Varavg和Sim_Varmax分别为1.5 ± 0.9 mm和2.1 ± 1.0 mm。Tx_Varavg和Tx_Varmax在LR方向上分别为1.2 ± 0.4 mm和2.0 ± 0.7 mm，在AP方向上分别为1.1 ± 0.4 mm和1.8 ± 0.6 mm，在SI方向上分别为1.9 ± 1.0 mm和3.1 ± 1.4 mm。ITV较GTV增加21.0% ± 8.6%。对于ITV和GTV，在LR和AP中包含>95%的基准位置所需的PTV边缘分别为2 mm和4 mm，在SI中分别为4 mm和6 mm。屏气间的变化并不是微不足道的，特别是在SI方向上。在模拟时采集多次屏气CT扫描可以帮助量化屏气间隔的再现性，并设计治疗的PSBH裕度。
In patients undergoing stereotactic body radiation therapy (SBRT) for pancreatic adenocarcinoma, the reproducibility of tumor positioning between deep-inspiration breath holds is unclear. We characterized this variation with fiducials at simulation and treatment and investigated whether a patient-specific breath-hold (PSBH) margin would help account for intrafraction variation at treatment. We analyzed 20 consecutive patients with pancreatic cancer who underwent SBRT with deep-inspiration breath holds. At simulation, 3 additional breath-hold scans were acquired immediately after the contrast-enhanced planning computed tomography (CT) scan and used to quantify the mean and maximum variations in the simulation fiducial position (Sim_Varavg and Sim_Varmax), as well as to design the internal target volume (ITV) incorporating a PSBH margin. At treatment, a mean of 5 breath-hold cone beam CT (CBCT) scans were acquired per fraction for each patient to quantify the mean and maximum variations in the treatment fiducial position (Tx_Varavg and Tx_Varmax). Various planning target volume (PTV) margins on the gross tumor volume (GTV) versus ITV were evaluated using CBCT scans, with the goal of >95% of fiducials being covered at treatment. The Sim_Varavg and Sim_Varmax were 0.9 ± 0.5 mm and 1.5 ± 0.8 mm in the left-right (LR) direction, 0.9 ± 0.4 mm and 1.4 ± 0.4 mm in the anteroposterior (AP) direction, and 1.5 ± 0.9 mm and 2.1 ± 1.0 mm in the superoinferior (SI) direction, respectively. The Tx_Varavg and Tx_Varmax were 1.2 ± 0.4 mm and 2.0 ± 0.7 mm in the LR direction, 1.1 ± 0.4 mm and 1.8 ± 0.6 mm in the AP direction, and 1.9 ± 1.0 mm and 3.1 ± 1.4 mm in the SI direction, respectively. The ITV was increased by 21.0% ± 8.6% compared with the GTV alone. The PTV margin necessary to encompass >95% of the fiducial locations was 2 mm versus 4 mm in both LR and AP and 4 mm versus 6 mm in SI for the ITV and the GTV, respectively. The interbreath-hold variation is not insignificant, especially in the SI direction. Acquiring multiple breath-hold CT scans at simulation can help quantify the reproducibility of the interbreath hold and design a PSBH margin for treatment.
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影响因子：
5.7
作者：
Josipovic, Mirjana;Persson, Gitte F.;Aznar, Marianne C.
通讯作者：
Aznar, Marianne C.
DOI：
10.1177/028418518402500208
发表时间：
1984-01-01
期刊：
ACTA RADIOLOGICA-DIAGNOSIS
影响因子：
--
作者：
SURAMO, I;PAIVANSALO, M;MYLLYLA, V
通讯作者：
MYLLYLA, V
影响因子：
5.7
作者：
Erridge, SC;Seppenwoolde, Y;Lebesque, JV
通讯作者：
Lebesque, JV
影响因子：
5.7
作者：
Keall, Paul J.;Doan Trang Nguyen;Booth, Jeremy T.
通讯作者：
Booth, Jeremy T.
影响因子：
3.8
作者：
Yi, Byong Yong;Han-Oh, Sarah;Yu, Cedric
通讯作者：
Yu, Cedric