Characterization of pancreatic tumor motion using cine MRI: surrogates for tumor position should be used with caution.
Characterization of pancreatic tumor motion using cine MRI: surrogates for tumor position should be used with caution.
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DOI：
10.1016/j.ijrobp.2009.02.003
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发表时间：
2009-07-01
影响因子：
7
通讯作者：
Ben-Josef, Edgar
中科院分区：
文献类型：
--
作者：
Feng, Mary;Balter, James M.;Normolle, Daniel;Adusumilli, Saroja;Cao, Yue;Chenevert, Thomas L.;Ben-Josef, Edgar
我们目前对胰腺肿瘤因呼吸而运动的理解非常有限。在这项研究中，我们的特点胰腺肿瘤的运动，并评估了几种放射治疗运动管理策略的应用。17例不可切除的胰腺癌患者入组了一项前瞻性IRB批准的研究，并在3 T扫描仪上使用电影MRI在浅自由呼吸期间进行成像。肿瘤边界由放射肿瘤学家和腹部MRI放射学家商定。评估肿瘤运动以及与横膈膜和腹壁潜在替代物的相关性。该数据也用于评估PTV边缘构建、呼吸门控和胰腺肿瘤的四维治疗计划。肿瘤边界的移动远超预期。为了提供99%的几何覆盖率，需要20 mm的前边缘、10 mm的前边缘、7 mm的上边缘和4 mm的后边缘。肿瘤位置与膈肌和腹壁位置相关性较差，患者水平Pearson相关系数为-0.18至0.43。用这些替代物进行门控的灵敏度和特异性也很差，为53- 68%，总体误差为35- 38%，表明肿瘤可能剂量不足，正常组织剂量过量。胰腺肿瘤边界的运动在患者之间存在很大差异，并且大于预期。随着呼吸，肿瘤有明显的变形，肿瘤边缘位置与腹壁或肿瘤位置没有很好的相关性。目前的运动管理策略可能无法完全解释肿瘤运动，应谨慎使用。
Our current understanding of intra-fraction pancreatic tumor motion due to respiration is quite limited. In this study, we characterized pancreatic tumor motion and evaluated the application of several radiotherapy motion management strategies. 17 patients with unresectable pancreatic cancer were enrolled in a prospective IRB-approved study and imaged during shallow free-breathing using cine MRI on a 3T scanner. Tumors borders were agreed upon by a radiation oncologist and an abdominal MRI radiologist. Tumor motion and correlation with the potential surrogates of the diaphragm and abdominal wall were assessed. This data was also used to evaluate PTV margin construction, respiratory gating, and 4-dimensional treatment planning for pancreatic tumors. Tumor borders moved much more than expected. To provide 99% geometric coverage, margins of 20mm inferiorly, 10mm anteriorly, 7 mm superiorly, and 4 mm posteriorly are required. Tumor position correlated poorly with diaphragm and abdominal wall position, with patient-level Pearson correlation coefficients of −0.18 to 0.43. Sensitivity and specificity of gating with these surrogates was also poor, at 53–68%, with overall error of 35–38%, suggesting that the tumor may be underdosed and normal tissues overdosed. Motion of pancreatic tumor borders is highly variable between patients and larger than expected. There is substantial deformation with breathing, and tumor border position does not correlate well with abdominal wall or diaphragmatic position. Current motion management strategies may not account fully for tumor motion and should be used with caution.
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DOI：
10.1016/j.ijrobp.2006.02.035
发表时间：
2006-07-01
影响因子：
7
作者：
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通讯作者：
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DOI：
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发表时间：
2004-04-01
影响因子：
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发表时间：
2000-09-01
影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
Spalding, Aaron C.;Jee, Kyung-Wook;Ben-Josef, Edgar
通讯作者：
Ben-Josef, Edgar