Delivery of magnetic resonance-guided single-fraction stereotactic lung radiotherapy.
Delivery of magnetic resonance-guided single-fraction stereotactic lung radiotherapy.
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DOI：
10.1016/j.phro.2020.05.002
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发表时间：
2020-04
影响因子：
--
通讯作者：
Senan S
中科院分区：
文献类型：
--
作者：
Finazzi T;van Sörnsen de Koste JR;Palacios MA;Spoelstra FOB;Slotman BJ;Haasbeek CJA;Senan S
MR引导能够实现高精度单次肺SABR输送。屏气门控导致平均跟踪GTVt覆盖率为99.6%，在射束上。桌上计划适应改善PTV覆盖率，但对GTV剂量影响不大。需要改进的技术来允许对小肿瘤进行一致的MR跟踪。单次立体定向消融放射治疗（SABR）是早期肺癌的有效治疗方法，但单次SABR的准确性仍存在问题。我们评价了使用磁共振（MR）引导的单次肺SABR的输送。对17名患者进行了MR模拟，发现其中7名患者不适合，这主要是由于对小肿瘤的跟踪不可靠。10名患者在0.35 T MR直线加速器系统上接受了34戈伊的单次SABR，并进行了在线计划调整。门控屏气SABR使用5 mm的计划靶体积（PTV）裕度和3 mm的门控窗口进行输送。在矢状面中对大体肿瘤体积（GTVt）进行连续MR跟踪，使用室内监视器提供视觉患者反馈。分析实时MR图像以确定门控输送的精度和效率。除一名患者外，所有患者均在一次治疗中完成治疗。中位总室内手术时间为120分钟，中位SABR分娩时间为39分钟。对7.4 h电影-MR成像的审查显示，在射束开启期间PTV的平均GTVt覆盖率为99.6%。屏气模式是可变的，导致平均占空比效率为51%，但由于实时MR引导，GTVt覆盖范围不受影响。桌上适应改善PTV覆盖率，但对GTV剂量的影响有限。肺肿瘤的单次门控SABR可以使用MR引导以高精度进行。然而，需要改进以确保小肿瘤的MR跟踪，并减少治疗时间。
MR-guidance enables high precision single-fraction lung SABR delivery. Breath-hold gating resulted in a mean tracked GTVt coverage of 99.6% during beam-on. On-table plan adaptation improved PTV coverage, but had little impact on GTV doses. Improved techniques are needed to allow for consistent MR-tracking of small tumors. Single-fraction stereotactic ablative radiotherapy (SABR) is an effective treatment for early-stage lung cancer, but concerns remain about the accurate delivery of SABR in a single session. We evaluated the delivery of single-fraction lung SABR using magnetic resonance (MR)-guidance. An MR-simulation was performed in 17 patients, seven of whom were found to be unsuitable, largely due to unreliable tracking of small tumors. Ten patients underwent single-fraction SABR to 34 Gy on a 0.35 T MR-linac system, with online plan adaptation. Gated breath-hold SABR was delivered using a planning target volume (PTV) margin of 5 mm, and a 3 mm gating window. Continuous MR-tracking of the gross tumor volume (GTVt) was performed in sagittal plane, with visual patient feedback provided using an in-room monitor. The real-time MR images were analyzed to determine precision and efficiency of gated delivery. All but one patient completed treatment in a single session. The median total in-room procedure was 120 min, with a median SABR delivery session of 39 min. Review of 7.4 h of cine-MR imaging revealed a mean GTVt coverage by the PTV during beam-on of 99.6%. Breath-hold patterns were variable, resulting in a mean duty cycle efficiency of 51%, but GTVt coverage was not influenced due to real-time MR-guidance. On-table adaptation improved PTV coverage, but had limited impact on GTV doses. Single-fraction gated SABR of lung tumors can be performed with high precision using MR-guidance. However, improvements are needed to ensure MR-tracking of small tumors, and to reduce treatment times.
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影响因子：
5.7
作者：
Guckenberger, Matthias;Andratschke, Nicolaus;Verellen, Dirk
通讯作者：
Verellen, Dirk
影响因子：
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作者：
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20.4
作者：
Griffioen, Gwendolyn H. M. J.;Lagerwaard, Frank J.;Senan, Suresh
通讯作者：
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