Abstract：Objective To study the geometric difference between six different ITV generation Methods from 4DCT for patients with non-small cell lung cancer (NSCLC) treated with stereotactic ablative radiotherapy technique (SABR). Methods Between Dec. 2013 and Mar. 2014, 16 patients were enrolled in this retrospective study. All patients underwent imaging with 4DCT scans. The MI and DI index were evaluated between six ITV generation methods:combining GTV from all 10 respiratory phases (ITV10);combining GTV from four respiratory phases, including two extreme phases (0% and 50%) plus two intermediate phases (20% and 70%)(ITVYeo) which was proposed by Seung-Gu Yeo of Soonchunhyang University;combining GTV from two extreme phases (ITVEI+EE).And combining GTV from five odd phases (10%, 30%, 50%, 70%, 90%)(ITVodd).Accordingly the ITVEVEN which was combined from the remaining five even phases (20%, 40%, 60%, 80%, 0%), and ITVAVG, ITVMIP were contoured from two reconstructed 4DCT sequences, finally, a method which was not sensitive to the tumor volume and motion characteristic was selected for clinical use. Data were compared using a variance analysis followed by Student-Newman-Keulsa test both in same group or between groups. At the same time, the volume and the three dimensional movements of the tumor, the relativity of MI and DI were analyzed by Multi-parameter regression analysis. Results The mean (range) tumor motion (RLR, RAP, RCC, and R3D) are 3.5 mm (1.4-8.4 mm), 4.5 mm (1.1-8.6 mm), 9.5 mm (0-10 mm), 12.3 mm (2.5-55.3 mm) respectively. The IGTVx volume are Underestimated by 25.7%, 35.6%, 17.9%, 12.8%, 3.6%, 4.8%(P=0.000) respectively. The MI index comparisons between six ITV generation Methods and ITV10 showed statistical significance:0.69, 0.62, 0.80, 0.86, 0.93, 0.91(P=0.006).The DI index showed no statistical significance:0.98, 0.98, 0.97, 0.97, 0.99, 0.98(P=0.130).The tumor size and motion amplitude were certified not the independent factors for the MI index of ITVodd and ITVEVEN. Conclusions IGTVODD/EVEN based on odd or even 4DCT phases is not sensitive to the tumor size or motion characteristic and is proved to have a good marching with ITV10 meanwhile maintaining a reasonable contouring efficiency, it can be recommend to the institutions which was not equipped with the deformable registration systems.
Li Xiadong,Deng Qinghua,Zhang Lidan et al. Research on the geometric difference between different ITV generation methods in non-small cell lung cancer treated with stereotactic radiotherapy[J]. Chinese Journal of Radiation Oncology, 2015, 24(6): 688-691.
[1] Rosenzweig KE,Fox JL,Yorke E,et al. Results of a phase I dose-escalation study using three-dimensional conformal radiotherapy in the treatment of inoperable nonsmall cell lung carcinoma[J].Cancer,2005,103(12):2118-2127. 103(10):2118-27 DOI:10.1007/L11767-005-0060-7 [2] 0nishi H,Shirato H,Nagata Y,et al. Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage Ⅰ non-small cell lung cancer:updated results of 257 patients in a Japanese multi-institutional study[J].J Thorac Oncol,2007,2(7 Suppl 3):S94-S100. [3] Chang JY,Dong L,Liu H,et al. Image-guided radiation therapy for nonsmall cell lung cancer[J].J Thorac Oncol,2008,3(3):177-186. DOI:10.1097/JTO.0b013e3181622bdd. [4] Ford EC, Mageras GS, Yorke E, Ling CC.Respiration-correlated spiral CT:a method of measuring respiratory-induced anatomic motion for radiation treatment planning[J].Med Phys,2003,30(1):88-97. DOI:10.1007/s11767-005-0060-7 [5] Yeo SG, Kim ES.Efficient approach for determining four-dimensional computed tomography-based internal target volume in stereotactic radiotherapy of lung cancer[J].Radiat Oncol J,2013,31(4):247-251.DOI:10.3857/roj.2013.31.4.247. [6] Boldea V,Sharp GC,Jiang SB,et al.4DCT lung motion estimation with deformable registration:quantification of motion nonlinearity and hysteresis[J].Med Phys,2008,35(3):1008-1018.DOI:35(3):1008-18 [7] Ehler ED, Tomé WA.Step and shoot IMRT to mobile targets and techniques to mitigate the interplay effect[J].Phys Med Biol,2009,54(13):4311-4324.DOI:10.1088/0031-9155/54/13/023. [8] Mancosu P,Sghedoni R,Bettinardi V,et al. Semiautomatic technique for defining the internal gross tumor volume of lung tumors close to liver/spleen cupola by 4DCT[J].Med Phys,2010,37(1):4572-4576. [9] Ezhil M,Vedam S,Balter P,et al. Determination of patient-specific internal gross tumor volumes for lung cancer using four-dimensional computed tomography[J].Radiat Oncol,2009,4(6):4.DOI 10.1186/1748-717X-4-4. [10] Hong Ge,Jing Cai,Chris R.et al. Quantification and minimization of uncertainties of internal target volume for stereotactic body radiation therapy of lung cancer[J]. Int J Radiat Oncol Biol Phys,2013,85(2):438-443. DOI:10.1016/j.ijrobp.2012.04.032.
2015, Vol. 24 
