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Four-dimensional computed tomography scan analysis of liver tumor motion treated with abdominal compression during stereotactic treatment
Zhao Ying1, Tang Yuan1, Liu Wenyang1, Li Ning1, Lei Junqin1,Chen Silin1, Shi Jinming1, Ma Huiying1, Zeng Qiang1, Song Yongwen1, Wang Shulian1, Ren Hua1, Liu Yueping1, Fang Hui1, Lu Ningning1, Tang Yu1, Qi Shunan1, Yang Yong1, Chen Bo1, Li Yexiong1, Jin Jing1,2
1Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; 2Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital&Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
AbstractObjective To explore the motion and influencing factors of implanted gold markers in guiding liver stereotactic body radiation therapy (SBRT) using abdominal compression. Methods Twenty patients with oligometastatic colorectal cancer or primary hepatocellular carcinoma from January 2016 to December 2019 were included. All patients were treated with SBRT under abdominal compression, with 1-3 gold markers were implanted within 2cm from the lesion before positioning. Four-dimensional computed tomography (4DCT) scan was used for treatment planning. The respiratory cycle was divided into 0-90% respiratory phase images based on the respiratory signal, which were reconstructed by the system (Pinnacle3 version 9.1;Philips Medical System, Madison, WI, USA), and cone beam CT validation images before radiation exposure were obtained. The liver volume was divided into 3 parts:within 2cm from the main hepatic portal vein, 2-5cm from the main hepatic portal vein, and>5cm from the main hepatic portal vein. The motion of different tumor locations was evaluated. Results The average intrafractional motion amplitude was (2.63±2.81)mm in the cranial-caudal (CC) direction,(1.35±1.23)mm in the anterior-posterior (AP) direction, and (0.76±0.88)mm in the left-right (LR) direction, respectively. The average interfractional motion amplitude was (3.45±3.06)mm,(2.64±2.60)mm, and (2.23±2.07)mm, respectively. Both the intra-or inter-fractional motion amplitudes in the CC direction were the highest, followed by those in the AP and LR direction (allP<0.001). The motion varied at different tumor locations. The longer distance from the main hepatic portal vein, the larger the intrafractional motion (allP<0.05). To cover the 95% population-based confidence interval, the internal target volume (ITV) was suggested to include the expansion of 3.9mm, 5.2mm and 7.9mm in the LR, AP and CC direction. The expansion of 4.3mm, 4.4mm and 6.1mm was delivered within 2cm from the main hepatic portal vein, and 3.5mm,7.3mm and 9.7mm>5cm from the main hepatic portal vein, respectively. The expansion varied significantly depending on the tumor location, whereas the motion in the CC direction was the largest regardless of the tumor location. The longer distance of the tumor from the main portal vein, the larger expansion in the CC direction. The expansion of tumor > 5cm from the main portal vein in the AP direction was larger than that ofinner parts. Conclusion Liver tumors at different locations require individual external expansion of ITV.
Corresponding Authors:
Jin Jing, Email:jinjing@csco.org.cn
Cite this article:
Zhao Ying,Tang Yuan,Liu Wenyang et al. Four-dimensional computed tomography scan analysis of liver tumor motion treated with abdominal compression during stereotactic treatment[J]. Chinese Journal of Radiation Oncology, 2021, 30(11): 1142-1147.
Zhao Ying,Tang Yuan,Liu Wenyang et al. Four-dimensional computed tomography scan analysis of liver tumor motion treated with abdominal compression during stereotactic treatment[J]. Chinese Journal of Radiation Oncology, 2021, 30(11): 1142-1147.
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