Abstract Objective To investigate the three-dimensional (3D) motion of gross tumor volume (GTV) and its influential factors in patients with primary thoracic esophageal cancer based on four-dimensional CT (4DCT). Methods Sixty-five patients with thoracic esophageal cancer underwent 3DCT and 4DCT simulation scans during normal breathing to measure the centroid motions of GTV in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions. The distances from the upper and lower edges of GTV to the lower edges of the aortic arch and tracheal carina and the diaphragmatic dome at both sides were measured. The patients were grouped based on age, sex, and the location, pathological type, volume, and length of tumor. The impacts of the above factors on GTV motion and the correlation between the positions of tumor upper/lower edges and GTV motion were analyzed. Results The centroid motions of GTV in the LR, AP, and SI directions were 0.15 cm, 0.12 cm, and 0.34 cm, respectively. The patients with lower thoracic esophageal cancer had lager centroid motions of GTV in the LR and AP directions than those with upper and middle thoracic esophageal cancer (P=0.036 and 0.014), but there was no significant difference in the centroid motion of GTV in the SI direction (P=0.123). There were no relationships between GTV motion and the sex, age, and body mass index (BMI) of patients (PLR=0.464, 0.962, and 0.727, PAP=0.924, 0.594, and 0.865, PSI=0.955, 0.264, and 0.139). A significant difference was found between patients with different tumor lengths in terms of the GTV motion in the LR direction (P=0.014). GTV motions were not correlated with whether lymph node metastasis occurred (P=0.502, 0.665, and 0.815), but they were negatively correlated with the distances between the upper and lower edges of GTV and the tracheal carina (P=0.000—0.014). Conclusions The maximum GTV motion is seen in the SI direction among patients with thoracic esophageal cancer during normal breathing. Age, sex, BMI, and mediastinal lymph node metastasis have no impacts on target volume expansion, and appropriate site-specific internal target volume expansion should be determined in consideration of the tumor location and the distances between the upper and lower edges of GTV and the tracheal carina.
Corresponding Authors:
LI Jian-bin, Email:lijianbin@msn.com
E-mail: lijianbin@msn.com
Cite this article:
WANG Wei,LI Jian-bin,QI Huan-peng et al. Respiratory motion of GTV and its influential factors in patients with primary thoracic esophageal cancer[J]. Chinese Journal of Radiation Oncology, 2013, 22(4): 282-285.
WANG Wei,LI Jian-bin,QI Huan-peng et al. Respiratory motion of GTV and its influential factors in patients with primary thoracic esophageal cancer[J]. Chinese Journal of Radiation Oncology, 2013, 22(4): 282-285.
[1] Hawkins MA, Brooks C, Hansen VN, et al. Cone beam computed tomography-derived adaptive radiotherapy for radical treatment ofesophageal cancer. Int J Radiat Oncol Biol Phys,2010,77:378-383. [2] Yaremko BP, Guerrero TM, McAleer MF, et al. Determination of respiratory motion for distal esophagus cancer using four-dimensional computed tomography. Int J Radiat Oncol Biol Phys,2008,70:145-153. [3] Yamashita H, Kida S, Sakumi A, et al. Four-dimensional measurement of the displacement ofinternal fiducial markers during 320-multislice computedtomographyscanning of thoracic esophagealcancer. Int J Radiat Oncol Biol Phys,2011,79:588-95. [4] Zhao KL, Liao Z, BuSIi MK, et al. Evaluation of respiratory induced target motion for esophageal tumors at the gastroesophageal junction. Radiother Oncol,2007,84:283-289. [5] Fukada J, Hanada T, Kawaguchi O, et al. Detection of esophageal fiducial marker displacement during radiation therapy with a 2-dimensional on-board imager:analysis of internal margin for esophageal cancer. Int J Radiat Oncol Biol Phys,2013,85:991-998. [6] 王玮,李建彬,张英杰,等.基于四维CT的胸中下段食管癌大体肿瘤体积和位移的相关研究.中华放射肿瘤学杂志,2012,21:140-143. [7] 张英杰,李建彬,王玮,等.基于四维CT的食管癌整体与分层测量内边界外扩距离的比较研究.中华放射肿瘤学杂志,2012,2:144-147. [8] Pan CC, Kashani R, Hayman JA, et al. Intra-and inter-fraction esophagus motion in 3D-conformal radiotherapy:implications for ICRU 62 definitions of internal target volume and planning organ at risk volume. Int J Radiat Oncol Biol Phys,2004,60:580-581. [9] Dieleman EM, Senan S, Vincent A, et al. Four-dimensional computed tomographic analysis of esophageal mobility during normal respiration. Int J Radiat Oncol Biol Phys,2007,67:775-780. [10] Wang J, Lin SH, Dong L, et al. Quantifying the interfractional displacement of the gastroesophageal junction during radiation therapy for esophageal cancer. Int J Radiat Oncol Biol Phys,2012,82:273-280. [11] Hashimoto T, Shirato H, Kato M, et al. Real-time monitoring of a digestive tract marker to reduce adverse effects of moving organs at risk (OAR) in radiotherapy for thoracic and abdominal tumors. Int J Radiat Oncol Biol Phys,2005,61:1559-1564.
2013, Vol. 22 
