Journal article
Geometric uncertainties in voluntary deep inspiration breath hold radiotherapy for locally advanced lung cancer.
- Josipovic M Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Denmark. Electronic address: mirjana.josipovic@regionh.dk.
- Persson GF Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark.
- Dueck J Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Denmark; Paul Scherrer Institute, 5232 Villigen PSI, Switzerland.
- Bangsgaard JP Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark.
- Westman G Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark.
- Specht L Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark; Faculty of Medical Sciences, University of Copenhagen, Denmark.
- Aznar MC Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Denmark; Faculty of Medical Sciences, University of Copenhagen, Denmark.
- 2015-12-04
Published in:
- Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. - 2016
Breath hold
Differential motion
Geometrical uncertainties
Lung cancer
Radiotherapy
Tumour position reproducibility
Aged
Breath Holding
Female
Humans
Hyperventilation
Lung Neoplasms
Lung Volume Measurements
Male
Middle Aged
Prospective Studies
Radiotherapy Planning, Computer-Assisted
Reproducibility of Results
Tomography, X-Ray Computed
Uncertainty
English
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.
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.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.radonc.2015.11.004
- PMID 26631647
- Persistent URL
- https://folia.unifr.ch/global/documents/173140
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