Variation in target volume and position in concurrent chemoradiotherapy for pancreatic cancer
Sun Jingui,Li Jianbin,Wei Hua,Wang Xiaofang,Yang Wenchao,Wang Jinzhi,Wang Yue,Liu Tonghai
Medicine and Life Sciences College of Shandong Academy of Medical Sciences,Jinan University,Ji’nan 250200,China (Sun JG);
Department of Radiation Oncology (Sun JG,Li JB,Wang JZH),Department of Radiology (Wang Y),Physical Planning Room (Liu TH),Shandong Cancer Hospital Affiliated to Shandong University,Ji’nan 250117,China;
Department of Oncology,Shouguang City People′s Hospital,Shouguang 206700,China (Wei H,Wang XF,Yang WCH)
Objective To investigate the variation in target volume and position in radiotherapy for pancreatic cancer based on contrast-enhanced three-dimensional computed tomography (3DCT) images,and to investigate the influence of radiotherapy re-planning during the treatment on doses to organs at risk. Methods Thirty-one patients with pancreatic cancer received contrast-enhanced 3DCT scans before radiotherapy and at the 15th-18th fraction. gross tumor volume (GTV) was delineated on the two sets of images. The coordinates and volume of GTV were acquired after automatic registration in the treatment planning system. Radiotherapy plan-1 and plan-2 were made based on the initial target volume (CT-1) and the target volume after 15th-18th fraction (CT-2),respectively. Plan-3 was defined by copying plan-1 to the CT-2. The results were analyzed using one-way analysis of variance and Pearson correlation analysis. Results During the treatment,the center of GTV had a significant larger displacement in the superior-inferior direction than in the right-left or anterior-posterior direction ((0.7±0.2) vs. (0.4±0.1) cm,(0.7±0.2) vs. (0.4±0.1) cm,P=0.048);the volume of GTV was significantly reduced by (27.1±17.1)%(P=0.000).The degrees of inclusion (DI) of the two GTVs were 0.6±0.2 and 0.8±0.2(P=0.000).The matching index (MI) was 0.5±0.1.The three-dimensional vector of GTV was negatively correlated with DI and MI (P=0.000,0.000,0.000).Compared with plan-3,the Dmean values for the liver and right kidney in plan-2 were significantly reduced by 21.9% and 14.4%,respectively (P=0.025,0.040). Conclusions The position and volume of GTV have significant changes during conventional fractionation radiotherapy combined with concurrent chemotherapy for pancreatic cancer. Re-planning during the treatment can significantly reduce doses to the liver and right kidney. Therefore,it is necessary to perform target correction and re-planning at an appropriate time during treatment.
Sun Jingui,Li Jianbin,Wei Hua et al. Variation in target volume and position in concurrent chemoradiotherapy for pancreatic cancer[J]. Chinese Journal of Radiation Oncology, 2016, 25(12): 1323-1326.
[1] Jemal A,Siegel R,Xu J,et al. Cancer statistics[J].CA Cancer J Clin,2010,60(5):277-300.10.3322/caac.20073.
[2] 赵玉沛.胰腺癌诊断与治疗的现状与未来[J].中华肝胆外科杂志,2009,15(5):321-323.10.3760/cma.j.issn.1007-8118.2009.05.001.Zhao YP.Current status and future of diagnosis and treatment of pancreatic cancer[J].Chin J Hepatobiliary Surg,2009,15(5):321-323.10.3760/cma.j.issn.1007-8118.2009.05.001.
[3] Hugllet F,Andre T,Hammel P,et al. Impact of chemoradiothempy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase Ⅱ and Ⅲ studies[J].J Clin Oncol,2007,25(3):326-331.
[4] Loehrer PJ,Powell ME,Cardenes HR,et al. A randomized phase Ⅲ study of gemcitabine in combination with radiation therapy versus gemcitabine alone in patients with localised,unresectable pancreatic cancer:E4201[J].J Clin Oncol,2008,26(15 Suppl abstc 4506).
[5] Small W Jr,Berlin J,Freedman GM,et alFull-dose gemeitabine with concurrent radiation therapy in patient with nonmetastatic pancreatic cancer:a multicenter phase Ⅱ trial[J].J Clin Oncol,2008,26(6):942-947.
[6] Hof H,Rhein B,Haering P,et al.4D-CT-based target volume definition in stereotactic radiotherapy of lung tumours:comparison with a conventional technique using individual margins[J].Radiother Oncal,2009,93(3):419-423.10.1016/j.radonc.2009.08.040.
[7] 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(1):l-14.
[8] Harris EJ,Donovan EM,Yarnold JR,el al. Characterization of target volume changes during breast radiotherapy using implanted fiducial markers and portal imaging[J].IntJ Radiat Oncol Biol Phys,2009,73(3):958-966.10.1016/j.ijrobp.2008.10.030.
[9] Hattangadi JA,Hong TS,Yeap BY,et al. Results and patterns of failure in patients treated with adjuvant combined chemoradiation therapy for resected pancreatic adenocarcinoma[J].Cancer,2009,115(16):3640-3650.10.1002/cncr.24410.
[10] Van den Broeck A,Sergeant G,Ectors N,et al. Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma[J].Eur J Surg Oncol,2009,35(6):600-604.10.1016/j.ejso.2008.12.006.
[11] Hajj C,Goodman KA.Role of Radiotherapy and newer techniques in the treatment of GI cancers[J].J Clin Oncol,2015,33(16):1737-1744.10.1200/JCO.2014.59.9787.
[12] Cattaneo GM,Passoni P,Sangalli G,et al. Internal target volume defined by contrast-enhanced 4D-CT scan in unresectable pancreatic tumor:evaluation and reproducibility[J].Radiother Oncol,2010,97(3):525-529.10.1016/j.radonc.2010.08.007.
[13] Goldstein SD,Ford EC,Duhon M,et al. Use of respiratory-correlated 4D-CT to determine acceptable treatment margins for locally advanced pancreatic adenocarcinoma[J].Int J Radiat Oncol Biol Phys,2010,76(2):597-602.10.1016/j.ijrobp.2009.06.009.
[14] Mori S,Hara R,Yanagi T,et al. Fourdimensional measurement of intrafractional respiratory motion of pancreatic tumours using a 256 multi-slice CT scanner[J].Radiother Oncol,2009,92(2):231-237.10.1016/j.radonc.2008.12.015.
[15] Jayachandran P,Minn AY,Van Dam J,et al. Interfractional uncertainty in the treatment of pancreatic cancer with radiation[J].Int J Radiat Oncol Biol Phys,2010,76(2):603-607.10.1016/j.ijrobp.2009.06.029.
[16] Amoush A,Abdel-Wahab M,Abazeed M,et al. Potential systematic uncertainties in IGRT when FBCT reference images are used for pancreatic tumors[J].J Appl Clin Med Phys,2015,16(3):5257.10.1120/jacmp.v16i3.5257.
[17] Gwynne S1,Wills L,Joseph G,et al. Respiratory movement of upper abdominal organs and its effect on radiotherapy planning in pancreatic cancer[J].Clin Oncol,2009,21(9):713-719.10.1016/j.clon.2009.07.015.
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