Geometric uncertainties in voluntary deep inspiration breath hold radiotherapy for locally advanced lung cancer
Geometric uncertainties in voluntary deep inspiration breath hold radiotherapy for locally advanced lung cancer
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DOI：
10.1016/j.radonc.2015.11.004
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发表时间：
2016-03-01
影响因子：
5.7
通讯作者：
Aznar, Marianne C.
中科院分区：
文献类型：
--
作者：
Josipovic, Mirjana;Persson, Gitte F.;Aznar, Marianne C.
背景和目的：深吸气屏气（DIBH）增加肺容量，并可能减少局部晚期肺癌的治疗相关毒性。我们估计几何不确定性视觉引导自愿DIBH和不同的图像引导strategy.Material和方法得出适当的治疗利润率：17例患者被纳入前瞻性。具有视觉引导的基于光学标记的呼吸监测能够实现舒适的DIBH，并根据每个患者的表现进行调整。所有患者在治疗部分2、16和31中的每一个都有三个连续的DIBH CT。DIBH的再现性进行了评估，肺体积，肿瘤的位置和差异之间的运动和纵隔淋巴nodes.Results：肺体积增加了中位数60%，DIBH的分数内的变化。分次间和分次内肺容积变化的中位数分别为2.1%和1.1%。3D肿瘤位置的分次间和分次内不确定度分别为4.8 ± 2.8 mm和1.7 ± 1.4 mm（平均值± SD）。分次间和分次内差分运动分别为4.8 +/- 3.3 mm和0.0 +/- 1.1 mm。结论：对于单个靶点，视觉引导自愿DIBH放疗具有高度可重复性，提供了图像引导策略与肿瘤配准。如果原发性肿瘤与纵隔淋巴结分离，分次间差分运动仍然是一个挑战，边缘必须适应，以反映图像配准策略。(C)2015爱思唯尔爱尔兰有限公司版权所有。
Background and purpose: Deep inspiration breath hold (DIBH) increases lung volume and can potentially reduce treatment-related toxicity in locally advanced lung cancer. We estimated geometric uncertainties in visually guided voluntary DIBH and derived the appropriate treatment margins for different image-guidance strategies.Material and methods: Seventeen patients were included prospectively. An optical marker-based respiratory monitoring with visual guidance enabled comfortable DIBHs, adjusted to each patient's performance. All patients had three consecutive DIBH CTs at each of the treatment fractions 2, 16 and 31. DIBH reproducibility was evaluated as inter- and intra-fractional variations in lung volume, tumour position and differential motion between primary tumour and mediastinal lymph nodes.Results: Lung volume increased by median 60% in DIBH. Inter- and intra-fractional lung volume variations were median 2.1% and 1.1%, respectively. Inter- and intra-fractional uncertainties in 3D tumour position were 4.8 +/- 2.8 mm and 1.7 +/- 1.4 mm (mean +/- SD). Inter- and intra-fractional differential motion was 4.8 +/- 3.3 mm and 0.0 +/- 1.1 mm.Conclusions: For single targets, visually guided voluntary DIBH radiotherapy is highly reproducible provided an image-guidance strategy with tumour registration is performed. If the primary tumour is separated from the mediastinal lymph nodes, inter-fractional differential motion remains a challenge and margins must be adapted to reflect the image registration strategy. (C) 2015 Elsevier Ireland Ltd. All rights reserved.