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Four-dimensional CT-based evaluation of intrafractional and interfractional anastomosis motion during postoperative radiotherapy in gastric cancer:a prospective study
Liu Wenyang, Jin Jing,Tian Yuan,Han Wei, Ren Hua, Fang Hui, Li Yexiong, Wang Shulian, Wang Weihu, Song Yongwen, Liu Yueping, Liu Xinfan, Yu Zihao
Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
Abstract Objective To study the intrafractional and interfractional anastomosis motion during postoperative adjuvant radiotherapy in gastric cancer by four-dimensional CT (4DCT). Methods Eight patients with locally advanced gastric cancer who underwent Billroth I gastrectomy and postoperative radiotherapy were enrolled in this study and prospective analysis was performed. A total of four 4DCT, preoperative and intraoperative, were performed during free breathing and dietary restriction. The implanted anastomotic nail was used as the observational subject, and the intrafractional and interfractional anastomosis motion was evaluated in the right-left (RL), anterior-posterior (AP), and superior-inferior (SI) directions. The relationship between the volume change in remnant stomach and interfractional anastomosis motion was analyzed. The differences within and between groups were analyzed by paired t test and one-way ANOVA, respectively. Results The intrafractional anastomosis motion was 2.4±2.3 mm, 2.1±2.0 mm, and 5.6±4.0 mm in RL, AP, and SI directions, respectively, and the motion in SI direction was significantly greater than that in RL and AP directions (P=0.000 and 0.000). The interfractional anastomosis motion was 6.1±6.6 mm, 3.3±3.0 mm, and 4.8±4.3 mm in RL, AP, and SI directions, respectively, with no significant differences between different directions (P=0.064,0.156,0.161). In RL direction, the interfractional anastomosis motion was significantly greater than the intrafractional anastomosis motion (P=0.018). The internal margins accounting for respiration related displacement and interfractional variability were 24.2 mm, 10.3 mm, and 18.3 mm in RL, AP and SI directions, respectively. Conclusions The intrafractional and interfractional anastomosis motion should be considered during postoperative adjuvant radiotherapy in gastric cancer patients who have undergone Billroth I gastrectomy. The internal margins required for anastomosis in RL, AP and SI directions are 24.2 mm, 10.3 mm and 18.3 mm, respectively.
Corresponding Authors:
Jin Jing,Email:jingjin1025@163.com
Cite this article:
Liu Wenyang,Jin Jing,Tian Yuan et al. Four-dimensional CT-based evaluation of intrafractional and interfractional anastomosis motion during postoperative radiotherapy in gastric cancer:a prospective study[J]. Chinese Journal of Radiation Oncology, 2015, 24(2): 163-167.
Liu Wenyang,Jin Jing,Tian Yuan et al. Four-dimensional CT-based evaluation of intrafractional and interfractional anastomosis motion during postoperative radiotherapy in gastric cancer:a prospective study[J]. Chinese Journal of Radiation Oncology, 2015, 24(2): 163-167.
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2015, Vol. 24 
