Effect of immobilization and performance status on intrafraction motion for stereotactic lung radiotherapy: analysis of 133 patients.
Int J Radiat Oncol Biol Phys
; 81(5): 1568-75, 2011 Dec 01.
Article
em En
| MEDLINE
| ID: mdl-21075559
ABSTRACT
PURPOSE:
To assess intrafractional geometric accuracy of lung stereotactic body radiation therapy (SBRT) patients treated with volumetric image guidance. METHODS AND MATERIALS Treatment setup accuracy was analyzed in 133 SBRT patients treated via research ethics board-approved protocols. For each fraction, a localization cone-beam computed tomography (CBCT) scan was acquired for soft-tissue registration to the internal target volume, followed by a couch adjustment for positional discrepancies greater than 3 mm, verified with a second CBCT scan. CBCT scans were also performed at intrafraction and end fraction. Patient positioning data from 2047 CBCT scans were recorded to determine systematic (Σ) and random (σ) uncertainties, as well as planning target volume margins. Data were further stratified and analyzed by immobilization method (evacuated cushion [n=75], evacuated cushion plus abdominal compression [n=33], or chest board [n=25]) and by patients' Eastern Cooperative Oncology Group performance status (PS) 0 (n=31), 1 (n=70), or 2 (n=32).RESULTS:
Using CBCT internal target volume was matched within ±3 mm in 16% of all fractions at localization, 89% at verification, 72% during treatment, and 69% after treatment. Planning target volume margins required to encompass residual setup errors after couch corrections (verification CBCT scans) were 4 mm, and they increased to 5 mm with target intrafraction motion (post-treatment CBCT scans). Small differences (<1 mm) in the cranial-caudal direction of target position were observed between the immobilization cohorts in the localization, verification, intrafraction, and post-treatment CBCT scans (p<0.01). Positional drift varied according to patient PS, with the PS 1 and 2 cohorts drifting out of position by mid treatment more than the PS 0 cohort in the cranial-caudal direction (p=0.04).CONCLUSIONS:
Image guidance ensures high geometric accuracy for lung SBRT irrespective of immobilization method or PS. A 5-mm setup margin suffices to address intrafraction motion. This setup margin may be further reduced by strategies such as frequent image guidance or volumetric arc therapy to correct or limit intrafraction motion.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Radiocirurgia
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Carcinoma Pulmonar de Células não Pequenas
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Tomografia Computadorizada de Feixe Cônico
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Imobilização
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Neoplasias Pulmonares
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Movimento
Tipo de estudo:
Guideline
Aspecto:
Ethics
Limite:
Aged
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Aged80
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Int J Radiat Oncol Biol Phys
Ano de publicação:
2011
Tipo de documento:
Article
País de afiliação:
Canadá