USE OF RESPIRATORY-CORRELATED FOUR-DIMENSIONAL COMPUTED TOMOGRAPHY TO DETERMINE ACCEPTABLE TREATMENT MARGINS FOR LOCALLY ADVANCED PANCREATIC ADENOCARCINOMA
USE OF RESPIRATORY-CORRELATED FOUR-DIMENSIONAL COMPUTED TOMOGRAPHY TO DETERMINE ACCEPTABLE TREATMENT MARGINS FOR LOCALLY ADVANCED PANCREATIC ADENOCARCINOMA
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DOI：
10.1016/j.ijrobp.2009.06.009
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发表时间：
2010-02-01
影响因子：
7
通讯作者：
Herman, Joseph M.
中科院分区：
文献类型：
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作者：
Goldstein, Seth D.;Ford, Eric C.;Herman, Joseph M.
目的：局部晚期胰腺癌呼吸引起的漂移会影响剂量传递。方法和材料：对30例局部晚期胰腺癌患者进行了呼吸相关的四维CT扫描，其中15例在降锥治疗前进行了重复扫描。治疗计划软件用于勾画大体肿瘤体积(GTV)、双侧肾脏和胆道支架的轮廓。结果：97%的局部晚期胰腺癌患者在SI方向的平均+/-标准差GTV漂移为0.55+/-0.23 cm，扩张1.0 cm可充分解释GTV的运动。生成了动态GTV，与静态GTV相比，平均音量增加了25%。在30例患者中，17例放置了胆道支架。SI支架平均漂移0.84+/-0.32 cm，明显大于GTV运动。剑突平均移动0.35+/-0.12 cm，明显小于GTV。左肾和右肾的SI运动平均值分别为0.65±0.27 cm和0.77±0.30 cm。在重复扫描时，平均GTV大小(p=.8)或偏移(p=.3)没有显著变化。结论：这些数据表明，如果在治疗计划期间不能用呼吸相关的四维计算机断层扫描来评估肿瘤的运动，建议沿SI、前后和内侧方向分别非对称地扩展1.0、0.7和0.6 cm。肿瘤运动的替代物，如胆道支架或外部标记物，应谨慎使用。(C)2010年爱思唯尔公司。
Purpose: Respiratory-induced excursions of locally advanced pancreatic adenocarcinoma could affect dose delivery. This study quantified tumor motion and evaluated standard treatment margins.Methods and Materials: Respiratory-correlated four-dimensional computed tomography images were obtained on 30 patients with locally advanced pancreatic adenocarcinoma; 15 of whom underwent repeat scanning before cone-down treatment. Treatment planning software was used to contour the gross tumor volume (GTV), bilateral kidneys, and biliary stent. Excursions were calculated according to the centroid of the contoured volumes.Results: The mean +/- standard deviation GTV excursion in the superoinferior (SI) direction was 0.55 +/- 0.23 cm; an expansion of 1.0 cm adequately accounted for the GTV motion in 97% of locally advanced pancreatic adenocarcinoma patients. Motion GTVs were generated and resulted in a 25% average volume increase compared with the static GTV. Of the 30 patients, 17 had biliary stents. The mean SI stent excursion was 0.84 +/- 0.32 cm, significantly greater than the GTV motion. The xiphoid process moved an average of 0.35 +/- 0.12 cm, significantly less than the GTV. The mean SI motion of the left and right kidneys was 0.65 +/- 0.27 cm and 0.77 +/- 0.30 cm, respectively. At repeat scanning, no significant changes were seen in the mean GTV size (p = .8) or excursion (p = .3).Conclusion: These data suggest that an asymmetric expansion of 1.0, 0.7, and 0.6 cm along the respective SI, anteroposterior, and medial-lateral directions is recommended if a respiratory-correlated four-dimensional computed tomography scan is not available to evaluate the tumor motion during treatment planning. Surrogates of tumor motion, such as biliary stents or external markers, should be used with caution. (C) 2010 Elsevier Inc.