TY - JOUR
T1 - A dosimetric analysis of respiration-gated radiotherapy in patients with stage III lung cancer
AU - Underberg, R. W M
AU - van Sörnsen de Koste, John R.
AU - Lagerwaard, Frank J.
AU - Vincent, Andrew
AU - Slotman, Ben J.
AU - Senan, Suresh
PY - 2006/3/31
Y1 - 2006/3/31
N2 - Background: Respiration-gated radiotherapy can permit the irradiation of smaller target volumes. 4DCT scans performed for routine treatment were retrospectively analyzed to establish the benefits of gating in stage III non-small cell lung cancer (NSCLC). Materials and methods: Gross tumor volumes (GTVs) were contoured in all 10 respiratory phases of a 4DCT scan in 15 patients with stage III NSCLC. Treatment planning was performed using different planning target volumes (PTVs), namely: (i) PTVroutine, derived from a single GTV plus 'conventional' margins; (ii) PTVallphases incorporating all 3D mobility captured by the 4DCT; (iii) PTVgating, incorporating residual 3D mobility in 3-4 phases at end-expiration. Mixed effect models were constructed in order to estimate the reductions in risk of lung toxicity for the different PTVs. Results: Individual GTVs ranged from 41.5 - 235.0 cm3. With patient-specific mobility data (PTVallphases), smaller PTVs were derived than when 'standard' conventional margins were used (p < 0.001). The average residual 3D tumor mobility within the gating window was 4.0 ± 3.5 mm, which was 5.5 mm less than non-gated tumor mobility (p < 0.001). The reductions in mean lung dose were 9.7% and 4.9%, respectively, for PTVallphases versus PTVroutine, and PTVgating versus PTVallphases. The corresponding reductions in V20 were 9.8% and 7.0%, respectively. Dosimetric gains were smaller for primary tumors of the upper lobe versus other locations (p = 0.02). Respiratory gating also reduced the risks of radiation-induced esophagitis. Conclusion: Respiration-gated radiotherapy can reduce the risk of pulmonary toxicity but the benefits are particularly evident for tumors of the middle and lower lobes.
AB - Background: Respiration-gated radiotherapy can permit the irradiation of smaller target volumes. 4DCT scans performed for routine treatment were retrospectively analyzed to establish the benefits of gating in stage III non-small cell lung cancer (NSCLC). Materials and methods: Gross tumor volumes (GTVs) were contoured in all 10 respiratory phases of a 4DCT scan in 15 patients with stage III NSCLC. Treatment planning was performed using different planning target volumes (PTVs), namely: (i) PTVroutine, derived from a single GTV plus 'conventional' margins; (ii) PTVallphases incorporating all 3D mobility captured by the 4DCT; (iii) PTVgating, incorporating residual 3D mobility in 3-4 phases at end-expiration. Mixed effect models were constructed in order to estimate the reductions in risk of lung toxicity for the different PTVs. Results: Individual GTVs ranged from 41.5 - 235.0 cm3. With patient-specific mobility data (PTVallphases), smaller PTVs were derived than when 'standard' conventional margins were used (p < 0.001). The average residual 3D tumor mobility within the gating window was 4.0 ± 3.5 mm, which was 5.5 mm less than non-gated tumor mobility (p < 0.001). The reductions in mean lung dose were 9.7% and 4.9%, respectively, for PTVallphases versus PTVroutine, and PTVgating versus PTVallphases. The corresponding reductions in V20 were 9.8% and 7.0%, respectively. Dosimetric gains were smaller for primary tumors of the upper lobe versus other locations (p = 0.02). Respiratory gating also reduced the risks of radiation-induced esophagitis. Conclusion: Respiration-gated radiotherapy can reduce the risk of pulmonary toxicity but the benefits are particularly evident for tumors of the middle and lower lobes.
UR - http://www.scopus.com/inward/record.url?scp=33846239895&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/1748-717X-1-8
DO - https://doi.org/10.1186/1748-717X-1-8
M3 - Article
SN - 1748-717X
VL - 1
JO - Radiation Oncology
JF - Radiation Oncology
IS - 1
M1 - 8
ER -