- 作者：Stine Korreman ; Ph.D.&lowast ; ; &dagger ; ; &Dagger ; ; ¶ ; ; korreman@ruc.dk ; Gitte Persson ; M.D. ; Ph.D.&dagger ; ; Ditte Nygaard ; M.Sc.&dagger ; ; Carsten Brink ; Ph.D.§ ; ; &lowast ; &lowast ; ; Trine Juhler-Nø ; ttrup ; M.D. ; Ph.D.&dagger ; &dagger ;
- 关键词：4DCT ; IGRT ; Lung cancer ; Motion management ; Respiratory gating
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 期刊代码：136_03603016
- 类别：med
- 出版时间：15 July, 2012
- 卷：83
- 期：4
- 页码：1338-1343
- 文件大小：304 K
Purpose
The purpose of this study was to quantify the effects of four-dimensional computed tomography (4DCT), 4D image guidance (4D-IG), and beam gating on calculated treatment field margins in a lung cancer patient population.Materials and Methods
Images were acquired from 46 lung cancer patients participating in four separate protocols at three institutions in Europe and the United States. Seven patients were imaged using fluoroscopy, and 39 patients were imaged using 4DCT.
The magnitude of respiratory tumor motion was measured. The required treatment field margins were calculated using a statistical recipe (van Herk M, et聽al. Int J Radiat Oncol Biol Phys 2000;474:1121-1135), with magnitudes of all uncertainties, except respiratory peak-to-peak displacement, the same for all patients, taken from literature. Required margins for respiratory motion management were calculated using the residual respiratory tumor motion for each patient for various motion management strategies. Margin reductions for respiration management were calculated using 4DCT, 4D-IG, and gated beam delivery.
Results
The median tumor motion magnitude was 4.4 mm for the 46 patients (range 0-29.3 mm). This value corresponded to required treatment field margins of 13.7 to 36.3聽mm (median 14.4 mm). The use of 4DCT, 4D-IG, and beam gating required margins that were reduced by 0 to 13.9 mm (median 0.5 mm), 3 to 5.2 mm (median 5.1 mm), and 0 to 7 mm (median 0.2 mm), respectively, to a total of 8.5 to 12.4 mm (median 8.6 mm).
Conclusion
A respiratory management strategy for lung cancer radiotherapy including planning on 4DCT scans and daily image guidance provides a potential reduction of 37%to 47%in treatment field margins. The 4D image guidance strategy was the most effective strategy for >85%of the patients.