Hepatic arterial phase and portal venous phase computed tomography for dose calculation of stereotactic body radiation therapy plans in liver cancer: a dosimetric comparison study

Radiation Oncology

Nianyong Chen¹  Guangjun Li¹  Xiaoqin Jiang¹  Yongsheng Wang¹  Fraser Henderson Jr²  Lan Sun¹  Qingfeng Jiang¹  Yan Li¹  Jianghong Xiao¹ 

[1] Center for Radiation Physics and Technology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China;University of Virginia School of Medicine, Charlottesville, Va 22908, USA

关键词: Volumetric modulated arc therapy;    Stereotactic body radiation therapy;    Portal venous phase CT;    Hepatic arterial phase CT;    Dose calculation;    Contrast agent;    Liver cancer;   

Others  :  1152414
DOI  :  10.1186/1748-717X-8-264

 received in 2013-06-28, accepted in 2013-11-06,  发布年份 2013

【 摘 要 】

Purpose

To investigate the effect of computed tomography (CT) using hepatic arterial phase (HAP) and portal venous phase (PVP) contrast on dose calculation of stereotactic body radiation therapy (SBRT) for liver cancer.

Methods

Twenty-one patients with liver cancer were studied. HAP, PVP and non-enhanced CTs were performed on subjects scanned in identical positions under active breathing control (ABC). SBRT plans were generated using seven-field three-dimensional conformal radiotherapy (7 F-3D-CRT), seven-field intensity-modulated radiotherapy (7 F-IMRT) and single-arc volumetric modulated arc therapy (VMAT) based on the PVP CT. Plans were copied to the HAP and non-enhanced CTs. Radiation doses calculated from the three phases of CTs were compared with respect to the planning target volume (PTV) and the organs at risk (OAR) using the Friedman test and the Wilcoxon signed ranks test.

Results

SBRT plans calculated from either PVP or HAP CT, including 3D-CRT, IMRT and VMAT plans, demonstrated significantly lower (p <0.05) minimum absorbed doses covering 98%, 95%, 50% and 2% of PTV (D98%, D95%, D50% and D2%) than those calculated from non-enhanced CT. The mean differences between PVP or HAP CT and non-enhanced CT were less than 2% and 1% respectively. All mean dose differences between the three phases of CTs for OARs were less than 2%.

Conclusions

Our data indicate that though the differences in dose calculation between contrast phases are not clinically relevant, dose underestimation (IE, delivery of higher-than-intended doses) resulting from CT using PVP contrast is larger than that resulting from CT using HAP contrast when compared against doses based upon non-contrast CT in SBRT treatment of liver cancer using VMAT, IMRT or 3D-CRT.

【 授权许可】

   
2013 Xiao et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Llovet JM, Burroughs A, Bruix J: Hepatocellular carcinoma. Lancet 2003, 362:1907-1917.
• [2]Grover A, Alexander HR Jr: The past decade of experience with isolated hepatic perfusion. Oncologist 2004, 9:653-664.
• [3]Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, Montalto F, Ammatuna M, Morabito A, Gennari L: Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996, 334:693-699.
• [4]Small R, Lubezky N, Ben-Haim M: Current controversies in the surgical management of colorectal cancer metastases to the liver. Isr Med Assoc J 2007, 9:742-747.
• [5]Rusthoven KE, Kavanagh BD, Cardenes H, Stieber VW, Burri SH, Feigenberg SJ, Chidel MA, Pugh TJ, Franklin W, Kane M, Gaspar LE, Schefter TE: Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol 2009, 27:1572-1578.
• [6]Cárdenes HR, Price TR, Perkins SM, Maluccio M, Kwo P, Breen TE, Henderson MA, Schefter TE, Tudor K, Deluca J, Johnstone PA: Phase I feasibility trial of stereotactic body radiation therapy for primary hepatocellular carcinoma. Clin Transl Oncol 2010, 12:218-225.
• [7]Wang PM, Hsu WC, Chung NN, Chang FL, Fogliata A, Cozzi L: Radiation treatment with volumetric modulated arc therapy of hepatocellular carcinoma patients: early clinical outcome and toxicity profile from a retrospective analysis of 138 patients. Radiat Oncol 2012, 7:207. BioMed Central Full Text
• [8]Giraud P, Elles S, Helfre S, De Rycke Y, Servois V, Carette MF, Alzieu C, Bondiau PY, Dubray B, Touboul E, Housset M, Rosenwald JC, Cosset JM: Conformal radiotherapy for lung cancer: different delineation of the gross tumor volume (GTV) by radiologists and radiation oncologists. Radiother Oncol 2002, 62:27-36.
• [9]Ichikawa T, Federle MP, Grazioli L, Nalesnik M: Hepatocellular adenoma: multiphasic CT and histopathologic findings in 25 patients. Radiology 2000, 214:861-868.
• [10]Scott DJ, Guthrie JA, Arnold P, Ward J, Atchley J, Wilson D, Robinson PJ: Dual phase helical CT versus portal venous phase CT for the detection of colorectal liver metastases: correlation with intra-operative sonography, surgical and pathological findings. Clin Radiol 2001, 56:235-242.
• [11]Robar JL, Ricco SA, Martin MA: Tumour dose enhancement using modified megavoltage photon beams and contrast media. Phys Med Biol 2002, 47:2433-2449.
• [12]Ramm U, Damrau M, Mose S, Manegold KH, Rahl CG, Böttcher HD: Influence of CT contrast agents on dose calculations in a 3D treatment planning system. Phys Med Biol 2001, 46:2631-2635.
• [13]Xiao J, Zhang H, Gong Y, Fu Y, Tang B, Wang S, Jiang Q, Li P: Feasibility of using intravenous contrast-enhanced computed tomography (CT) scans in lung cancer treatment planning. Radiother Oncol 2010, 96:73-77.
• [14]Choi Y, Kim JK, Lee HS, Hur WJ, Hong YS, Park S, Ahn K, Cho H: Influence of intravenous contrast agent on dose calculations of intensity modulated radiation therapy plans for head and neck cancer. Radiother Oncol 2006, 81:158-162.
• [15]Burridge NA, Rowbottom CG, Burt PA: Effect of contrast-enhanced CT scans on heterogeneity corrected dose computations in the lung. J Appl Clin Med Phys 2006, 7:1-12.
• [16]Shibamoto Y, Naruse A, Fukuma H, Ayakawa S, Sugie C, Tomita N: Influence of contrast materials on dose calculation in radiotherapy planning using computed tomography for tumors at various anatomical regions: a prospective study. Radiother Oncol 2007, 84:52-55.
• [17]Case RB, Moseley DJ, Sonke JJ, Eccles CL, Dinniwell RE, Kim J, Bezjak A, Milosevic M, Brock KK, Dawson LA: Interfraction and intrafraction changes in amplitude of breathing motion in stereotactic liver radiotherapy. Int J Radiat Oncol Biol Phys 2010, 77:918-925.
• [18]Fotina I, Winkler P, Künzler T, Reiterer J, Simmat I, Georg D: Advanced kernel methods vs. Monte Carlo-based dose calculation for high energy photon beams. Radiother Oncol 2009, 93:645-653.
• [19]Knöös T, Wieslander E, Cozzi L, Brink C, Fogliata A, Albers D, Nyström H, Lassen S: Comparison of dose calculation algorithms for treatment planning in external photon beam therapy for clinical situations. Phys Med Biol 2006, 51:5785-5807.