Assessing respiration-induced tumor motion and internal target volume using four-dimensional computed tomography for radiotherapy of lung cancer
Assessing respiration-induced tumor motion and internal target volume using four-dimensional computed tomography for radiotherapy of lung cancer
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DOI：
10.1016/j.ijrobp.2006.12.066
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发表时间：
2007-06-01
影响因子：
7
通讯作者：
Dong, Lei
中科院分区：
文献类型：
--
作者：
Liu, H. Helen;Balter, Peter;Dong, Lei
目的：探讨呼吸和内靶区体积(ITV)对肺癌放射治疗的三维肿瘤运动的影响。方法与材料：对152例肺癌患者的166个肿瘤进行呼吸诱导肿瘤运动分析，其中57.2%为III、IV期非小细胞肺癌。所有患者在治疗前均在正常呼吸状态下进行四维CT检查。以4DCT图像的呼气相为参考值，勾画大体肿瘤体积(GTV)。通过4DCT图像的刚体配准，确定其他呼吸期的大体肿瘤体积和由此产生的ITV。结果：在正常呼吸状态下，肿瘤沿上、下、外、后三个轴向移动0.5 cm的比例分别为39.2%、1.8%和5.4%。95%的肿瘤沿SI、外侧和AP方向的运动幅度小于1.34 cm、0.40 cm和0.59 cm。肿瘤运动的主要成分是SI方向，只有10.8%的肿瘤移动了1.0 cm。肿瘤的运动与横隔膜的运动、SI肿瘤在肺内的位置、GTV的大小和疾病的T分期有关。除位于肺下半部的小病变外，局部进展期肺部肿瘤在安静的正常呼吸期间的运动不太可能超过1.0厘米。(C)2007年爱思唯尔公司。
Purpose: To assess three-dimensional tumor motion caused by respiration and internal target volume (ITV) for radiotherapy of lung cancer.Methods and Materials: Respiration-induced tumor motion was analyzed for 166 tumors from 152 lung cancer patients, 57.2% of whom had Stage III or IV non-small-cell lung cancer. All patients underwent four-dimensional computed tomography (4DCT) during normal breathing before treatment. The expiratory phase of 4DCT images was used as the reference set to delineate gross tumor volume (GTV). Gross tumor volumes on other respiratory phases and resulting ITVs were determined using rigid-body registration of 4DCT images. The association of GTV motion with various clinical and anatomic factors was analyzed statistically.Results: The proportions of tumors that moved > 0.5 cm along the superior-inferior (SI), lateral, and anterior-posterior (AP) axes during normal breathing were 39.2 %, 1.8 %, and 5.4 %, respectively. For 95 % of the tumors, the magnitude of motion was less than 1.34 cm, 0.40 cm, and 0.59 cm along the SI, lateral, and AP directions. The principal component of tumor motion was in the SI direction, with only 10.8 % of tumors moving > 1.0 cm. The tumor motion was found to be associated with diaphragm motion, the SI tumor location in the lung, size of the GTV, and disease T stage.Conclusions: Lung tumor motion is primarily driven by diaphragm motion. The motion of locally advanced lung tumors is unlikely to exceed 1.0 cm during quiet normal breathing except for small lesions located in the lower half of the lung. (C) 2007 Elsevier Inc.