Oesophageal IGRT considerations for SBRT of LA-NSCLC: barium-enhanced CBCT and interfraction motion

Radiation Oncology

Trieumy Tran Le¹  Stephanie Miller¹  Vanessa Panettieri²  Jeremy D. Ruben³  Sashendra Senthi³  Katrina Woodford³  Sidney Davis³ 

[1] Alfred Health Radiation Oncology, The Alfred, 55 Commercial Road, 3004, Melbourne, VIC, Australia;Alfred Health Radiation Oncology, The Alfred, 55 Commercial Road, 3004, Melbourne, VIC, Australia;Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC, Australia;Alfred Health Radiation Oncology, The Alfred, 55 Commercial Road, 3004, Melbourne, VIC, Australia;Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia;

关键词: Oesophagus;    Barium;    Contrast;    IGRT;    Interfraction motion;    CBCT;    SBRT;   

DOI  :  10.1186/s13014-021-01946-8

来源: Springer

【 摘 要 】

BackgroundTo determine the optimal volume of barium for oesophageal localisation on cone-beam CT (CBCT) for locally-advanced non-small cell lung cancers (NSCLC) and quantify the interfraction oesophageal movement relative to tumour.MethodsTwenty NSCLC patients with mediastinal and/or hilar disease receiving radical radiotherapy were recruited. The first five patients received 25 ml of barium prior to their planning CT and alternate CBCTs during treatment. Subsequent five patient cohorts, received 15 ml, 10 ml and 5 ml. Six observers contoured the oesophagus on each of the 107 datasets and consensus contours were created. Overall 642 observer contours were generated and interobserver contouring reproducibility was assessed. The kappa statistic, dice coefficient and Hausdorff Distance (HD) were used to compare barium-enhanced CBCTs and non-enhanced CBCTs. Oesophageal displacement was assessed using the HD between consensus contours of barium-enhanced CBCTs and planning CTs.ResultsInterobserver contouring reproducibility was significantly improved in barium-enhanced CBCTs compared to non-contrast CBCTs with minimal difference between barium dose levels. Only 10 mL produced a significantly higher kappa (0.814, p = 0.008) and dice (0.895, p = 0.001). The poorer the reproducibility without barium, the greater the improvement barium provided. The median interfraction HD between consensus contours was 4 mm, with 95% of the oesophageal displacement within 15 mm.Conclusions10 mL of barium significantly improves oesophageal localisation on CBCT with minimal image artifact. The oesophagus moves substantially and unpredictably over a course of treatment, requiring close daily monitoring in the context of hypofractionation.

【 授权许可】

CC BY