Temporary organ displacement coupled with image-guided, intensity-modulated radiotherapy for paraspinal tumors

Radiation Oncology

Yoshiya Yamada¹  Raymond H Thornton⁴  Joseph P Erinjeri⁴  Daniel E Spratt¹  Michael Lovelock³  Nadeem Riaz¹  Greg Niyazov³  Douglas Housman²  Majid Maybody⁴  Stephen B Solomon⁴  Evangelia Katsoulakis¹ 

[1] Departments of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA;The Harold Leever Regional Cancer Center, Waterbury, CT, USA;Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA;Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA

关键词: Image guidance;    Radiosurgery;    Organ displacement;   

Others  :  1153711
DOI  :  10.1186/1748-717X-8-150

 received in 2012-12-24, accepted in 2013-06-01,  发布年份 2013

【 摘 要 】

Background

To investigate the feasibility and dosimetric improvements of a novel technique to temporarily displace critical structures in the pelvis and abdomen from tumor during high-dose radiotherapy.

Methods

Between 2010 and 2012, 11 patients received high-dose image-guided intensity-modulated radiotherapy with temporary organ displacement (TOD) at our institution. In all cases, imaging revealed tumor abutting critical structures. An all-purpose drainage catheter was introduced between the gross tumor volume (GTV) and critical organs at risk (OAR) and infused with normal saline (NS) containing 5-10% iohexol. Radiation planning was performed with the displaced OARs and positional reproducibility was confirmed with cone-beam CT (CBCT). Patients were treated within 36 hours of catheter placement. Radiation plans were re-optimized using pre-TOD OARs to the same prescription and dosimetrically compared with post-TOD plans. A two-tailed permutation test was performed on each dosimetric measure.

Results

The bowel/rectum was displaced in six patients and kidney in four patients. One patient was excluded due to poor visualization of the OAR; thus 10 patients were analyzed. A mean of 229 ml (range, 80–1000) of NS 5-10% iohexol infusion resulted in OAR mean displacement of 17.5 mm (range, 7–32). The median dose prescribed was 2400 cGy in one fraction (range, 2100–3000 in 3 fractions). The mean GTV D_min and PTV D_min pre- and post-bowel TOD IG-IMRT dosimetry significantly increased from 1473 cGy to 2086 cGy (p=0.015) and 714 cGy to 1214 cGy (p=0.021), respectively. TOD increased mean PTV D95 by 27.14% of prescription (p=0.014) while the PTV D05 decreased by 9.2% (p=0.011). TOD of the bowel resulted in a 39% decrease in mean bowel D_max (p=0.008) confirmed by CBCT. TOD of the kidney significantly decreased mean kidney dose and D_max by 25% (0.022).

Conclusions

TOD was well tolerated, reproducible, and facilitated dose escalation to previously radioresistant tumors abutting critical structures while minimizing dose to OARs.

【 授权许可】

   
2013 Katsoulakis et al.; licensee BioMed Central Ltd.

【 图 表 】

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