Incorporating breath holding and image guidance in the adjuvant gastric cancer radiotherapy: a dosimetric study

Radiation Oncology

Zhen Zhang¹  Qing Xu¹  Jiazhou Wang¹  Jinsong Ye²  Weigang Hu¹ 

[1] Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, 200032;Department of Radiation Oncology, Swedish Caner Institute, Seattle, WA, USA

关键词: Dose convolution;    Image-guided radiotherapy;    Breath holding;    Intensity-modulated radiotherapy;    Gastric cancer;   

Others  :  1160818
DOI  :  10.1186/1748-717X-7-98

 received in 2012-01-09, accepted in 2012-06-20,  发布年份 2012

【 摘 要 】

Background

The respiratory related target motion and setup error will lead to a large margin in the gastric radiotherapy. The purpose of this study is to investigate the dosimetric benefit and the possibility of incorporating the breath-hold (BH) technique with online image-guided radiotherapy in the adjuvant gastric cancer radiotherapy.

Methods

Setup errors and target motions of 22 post-operative gastric cancer patients with surgical clips were analyzed. Clips movement was recorded using the digital fluoroscopics and the probability distribution functions (pdf) of the target motions were created for both the free breathing (FB) and BH treatment. For dosimetric comparisons, two intensity-modulated radiotherapy (IMRT) treatment plans, i.e. the free breathing treatment plan (IMRT_FB) and the image-guided BH treatment plan (IMRT_IGBH) using the same beam parameters were performed among 6 randomly selected patients. Different margins for FB and BH plans were derived. The plan dose map was convoluted with various pdfs of the setup errors and the target motions. Target coverage and dose to organs at risk were compared and the dose-escalation probability was assessed.

Results

The mean setup errors were 1.2 mm in the superior-inferior (SI), 0.0 mm in the left-right (LR), and 1.4 mm in the anterior-posterior (AP) directions. The mean target motion for the free breathing (vs. BH) was 11.1 mm (vs. 2.2 mm), 1.9 mm (vs. 1.1 mm), and 5.5 mm (vs. 1.7 mm) in the SI, LR, and AP direction, respectively. The target coverage was comparable for all the original plans. IMRT_IGBH showed lower dose to the liver compared with IMRT_FB (p = 0.01) but no significant difference in the kidneys. Convolved IMRT_IGBH showed better sparing in kidneys (p < 0.01) and similar in liver (p = 0.08).

Conclusions

Combining BH technique with online image guided IMRT can minimize the organ motion and improve the setup accuracy. The dosimetric comparison showed the dose could be escalated to 54 Gy without increasing the critical organs toxicities, although further clinical data is needed.

【 授权许可】

   
2012 Hu et al.; licensee BioMed Central Ltd.

【 图 表 】

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