Diaphragm-Based Position Verification to Improve Daily Target Dose Coverage in Proton and Photon Radiation Therapy Treatment of Distal Esophageal Cancer
Autor: | Lydia A. den Otter, Cássia O. Ribeiro, Johannes A. Langendijk, Erik W Korevaar, Christina T. Muijs, S. Visser, Nanna M. Sijtsema, Stefan Both, Antje Knopf |
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Přispěvatelé: | Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS) |
Jazyk: | angličtina |
Rok vydání: | 2022 |
Předmět: |
Organs at Risk
Cancer Research INTERPLAY Proton Esophageal Neoplasms IMPACT Photon radiation therapy Diaphragm ANATOMICAL CHANGES Position (vector) SETUP Proton Therapy Medicine Humans Radiology Nuclear Medicine and imaging Proton therapy Radiation business.industry Radiotherapy Planning Computer-Assisted Radiotherapy Dosage Esophageal cancer QUANTIFICATION musculoskeletal system medicine.disease Intensity (physics) Diaphragm (structural system) ROBUSTNESS EVALUATION Target dose FIDUCIAL MARKERS Oncology RESPIRATORY MOTION Radiotherapy Intensity-Modulated Protons business Nuclear medicine TUMOR MOTION RADIOTHERAPY |
Zdroj: | International Journal of Radiation Oncology, Biology, Physics, 112(2), 463-474. ELSEVIER SCIENCE INC |
ISSN: | 0360-3016 |
DOI: | 10.1016/j.ijrobp.2021.09.015 |
Popis: | Purpose: In modern conformal radiation therapy of distal esophageal cancer, target coverage can be affected by variations in the diaphragm position. We investigated if daily position verification (PV) extended by a diaphragm position correction would optimize target dose coverage for esophageal cancer treatment.Methods and Materials: For 15 esophageal cancer patients, intensity modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) plans were computed. Displacements of the target volume were correlated with diaphragm displacements using repeated 4-dimensional computed tomography images to determine the correction needed to account for diaphragm variations. Afterwards, target coverage was evaluated for 3 PV approaches based on: (1) bony anatomy (PV_B), (2) bony anatomy corrected for the diaphragm position (PV_BD) and (3) target volume (PV_T).Results: The cranial-caudal mean target displacement was congruent with almost half of the diaphragm displacement (y = 0.459x), which was used for the diaphragm correction in PV_BD. Target dose coverage using PV_B was adequate for most patients with diaphragm displacements up till 10 mm (>= 94% of the dose in 98% of the volume [D-98%]). For larger displacements, the target coverage was better maintained by PV_T and PV_BD. Overall, PV_BD accounted best for target displacements, especially in combination with tissue density variations (D-98%: IMPT 94% +/- 5%, VMAT 96% +/- 5%). Diaphragm displacements of more than 10 mm were observed in 22% of the cases.Conclusions: PV_B was sufficient to achieve adequate target dose coverage in case of small deviations in diaphragm position. However, large deviations of the diaphragm were best mitigated by PV_BD. To detect the cases where target dose coverage could be compromised due to diaphragm position variations, we recommend monitoring of the diaphragm position before treatment through online imaging. (C) 2021 Elsevier Inc. All rights reserved. |
Databáze: | OpenAIRE |
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