In-vivo treatment accuracy analysis of active motion-compensated liver SBRT through registration of plan dose to post-therapeutic MRI-morphologic alterations
| Autor: | Guido Hildebrandt, Peter Hunold, Ardekani Leila Ghaderi, Floris Ernst, Frederik Wenz, Dirk Rades, Stefan Wurster, Judit Boda-Heggemann, Oliver Blanck, Ulrike I. Attenberger, Mark K. H. Chan, Anika Jahnke, Frank Lohr, Jürgen Dunst, Jost Philipp Schäfer |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Radiosurgery 030218 nuclear medicine & medical imaging Breath Holding Cohort Studies 03 medical and health sciences Active motion 0302 clinical medicine In vivo Medicine Humans Radiology Nuclear Medicine and imaging Statistical analysis Aged Retrospective Studies Aged 80 and over business.industry Radiotherapy Planning Computer-Assisted Liver Neoplasms Radiotherapy Dosage Hematology Robotics Middle Aged Magnetic Resonance Imaging Active motion-management DIBH Gantry-based SBRT In-vivo accuracy Normal tissue reactions Robotic SBRT Oncology Radiology Nuclear Medicine and Imaging Conformity index 030220 oncology & carcinogenesis Female Nuclear medicine business |
| Zdroj: | Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 134 |
| ISSN: | 1879-0887 |
| Popis: | In-vivo-accuracy analysis (IVA) of dose-delivery with active motion-management (gating/tracking) was performed based on registration of post-radiotherapeutic MRI-morphologic-alterations (MMA) to the corresponding dose-distributions of gantry-based/robotic SBRT-plans.Forty targets in two patient cohorts were evaluated: (1) gantry-based SBRT (deep-inspiratory breath-hold-gating; GS) and (2) robotic SBRT (online fiducial-tracking; RS). The planning-CT was deformably registered to the first post-treatment contrast-enhanced T1-weighted MRI. An isodose-structure cropped to the liver (ISL) and corresponding to the contoured MMA was created. Structure and statistical analysis regarding volumes, surface-distance, conformity metrics and center-of-mass-differences (CoMD) was performed.Liver volume-reduction was -43.1 ± 148.2 cc post-RS and -55.8 ± 174.3 cc post-GS. The mean surface-distance between MMA and ISL was 2.3 ± 0.8 mm (RS) and 2.8 ± 1.1 mm (GS). ISL and MMA volumes diverged by 5.1 ± 23.3 cc (RS) and 16.5 ± 34.1 cc (GS); the median conformity index of both structures was 0.83 (RS) and 0.80 (GS). The average relative directional errors were ≤0.7 mm (RS) and ≤0.3 mm (GS); the median absolute 3D-CoMD was 3.8 mm (RS) and 4.2 mm (GS) without statistically significant differences between the two techniques. Factors influencing the IVA included GTV and PTV (p = 0.041 and p = 0.020). Four local relapses occurred without correlation to IVA.For the first time a method for IVA was presented, which can serve as a benchmarking-tool for other treatment techniques. Both techniques have shown median deviations5 mm of planned dose and MMA. However, IVA also revealed treatments with errors ≥5 mm, suggesting a necessity for patient-specific safety-margins. Nevertheless, the treatment accuracy of well-performed active motion-compensated liver SBRT seems not to be a driving factor for local treatment failure. |
| Databáze: | OpenAIRE |
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