Fiducial-based image-guided SBRT for pancreatic adenocarcinoma: Does inter-and intra-fraction treatment variation warrant adaptive therapy?
Fiducial-based image-guided SBRT for pancreatic adenocarcinoma: Does inter-and intra-fraction treatment variation warrant adaptive therapy?
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DOI：
10.1186/s13014-021-01782-w
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发表时间：
2021-03-19
期刊：
影响因子：
--
通讯作者：
Narang AK
中科院分区：
文献类型：
--
作者：
Hill CS;Han-Oh S;Cheng Z;Wang KK;Meyer JJ;Herman JM;Narang AK
靶向定位的变化对立体定向全身放射治疗（SBRT）治疗胰腺腺癌（PDAC）的剂量传递的可重复性和可靠性提出了挑战。虽然用于基准匹配的机载成像允许每日移动以优化目标定位，但由于分数间和分数内变化而产生的移动幅度可能直接影响目标覆盖范围和对高危器官的剂量。在此，我们描述了在大容量机构接受SBRT治疗的PDAC患者的变异模式。我们回顾了30例连续使用主动呼吸协调（ABC）接受SBRT的患者。患者与骨对齐，然后转移到基准点。回顾了分数间和分数内扫描，以量化沿每个轴的平均和最大位移，以及位移幅度。采用线性回归模型研究了分数间和分数内位移之间的关系。LR、AP和SI轴的平均分数间偏移分别为3.1±1.8 mm、2.9±1.7 mm和3.5±2.2 mm，平均矢量偏移为6.4±2.3 mm。LR、AP和SI方向的平均分数内移位分别为2.0±0.9 mm、2.0±1.3 mm和2.3±1.4 mm，平均矢量移位为4.3±1.8 mm。线性回归模型显示，AP和SI轴的分数间和分数内偏移与偏移幅度之间存在显著关系。在使用SBRT治疗PDAC期间，即使采用ABC的综合运动管理策略，也会出现临床上显著的分数间和分数内变化。未来的研究应调查这些变化如何导致靶剂量和OAR的变化。在某些情况下，应考虑减轻剂量学影响的策略，包括实时成像和适应性治疗。在线版本包含补充资料，网址为10.1186/s13014-021-01782-w。
Variation in target positioning represents a challenge to set-up reproducibility and reliability of dose delivery with stereotactic body radiation therapy (SBRT) for pancreatic adenocarcinoma (PDAC). While on-board imaging for fiducial matching allows for daily shifts to optimize target positioning, the magnitude of the shift as a result of inter- and intra-fraction variation may directly impact target coverage and dose to organs-at-risk. Herein, we characterize the variation patterns for PDAC patients treated at a high-volume institution with SBRT. We reviewed 30 consecutive patients who received SBRT using active breathing coordination (ABC). Patients were aligned to bone and then subsequently shifted to fiducials. Inter-fraction and intra-fraction scans were reviewed to quantify the mean and maximum shift along each axis, and the shift magnitude. A linear regression model was conducted to investigate the relationship between the inter- and intra-fraction shifts. The mean inter-fraction shift in the LR, AP, and SI axes was 3.1 ± 1.8 mm, 2.9 ± 1.7 mm, and 3.5 ± 2.2 mm, respectively, and the mean vector shift was 6.4 ± 2.3 mm. The mean intra-fraction shift in the LR, AP, and SI directions were 2.0 ± 0.9 mm, 2.0 ± 1.3 mm, and 2.3 ± 1.4 mm, respectively, and the mean vector shift was 4.3 ± 1.8 mm. A linear regression model showed a significant relationship between the inter- and intra-fraction shift in the AP and SI axis and the shift magnitude. Clinically significant inter- and intra-fraction variation occurs during treatment of PDAC with SBRT even with a comprehensive motion management strategy that utilizes ABC. Future studies to investigate how these variations could lead to variation in the dose to the target and OAR should be investigated. Strategies to mitigate the dosimetric impact, including real time imaging and adaptive therapy, in select cases should be considered. The online version contains supplementary material available at 10.1186/s13014-021-01782-w.
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DOI：
10.1016/j.ijrobp.2003.09.077
发表时间：
2004-04-01
影响因子：
7
作者：
Gierga, DP;Chen, GTY;Willett, CG
通讯作者：
Willett, CG
影响因子：
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作者：
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影响因子：
4
作者：
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Lee, Percy P.
影响因子：
9
作者：
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通讯作者：
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