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Accuracy of Breath-hold CT in Treatment Planning for Lung Stereotactic Ablative Radiotherapy.

Authors
  • Mathieu, Dominique1
  • Martel, Charles1
  • Campeau, Marie-Pierre1
  • Filion, Édith1
  • Roberge, David2
  • Bahig, Houda1
  • Vu, Toni1
  • Lambert, Louise1
  • Boudam, Karim3
  • Carrier, Jean-Francois1
  • 1 Department of Radiation Oncology, Centre hospitalier de l'université de Montréal (CHUM).
  • 2 Department of Oncology, Division of Radiation Oncology, McGill University Health Center ; Department of Radiology, Radiation Oncology and Nuclear Medicine, University of Montreal ; Department of Radiation Oncology, Centre hospitalier de l'université de Montréal (CHUM) ; Department of Oncology, Division of Radiation Oncology, McGill University Health Center.
  • 3 Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM).
Type
Published Article
Journal
Cureus
Publisher
Cureus, Inc.
Publication Date
Dec 22, 2014
Volume
6
Issue
12
Identifiers
DOI: 10.7759/cureus.236
PMID: 28003937
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The objectives of this study are (1) to measure concordance of tumor position on breath-hold (BH) computed tomography (CT) scans relative to the natural tumor path during free breathing (FB) and (2) to evaluate the benefits of the breathing monitoring device Abches (Apex Medical, Tokyo) for stereotactic ablative radiotherapy (SABR) treatment planning. In 53 lung cancer patients treated with CyberKnife™ robotic radiosurgery system, FB four-dimensional computerized tomography (4DCT) and end-expiration (EE) BH CT images were obtained. Extent of natural tumor motion was assessed with rigid registration derived from end-inspiration (EI) and EE phases of the 4DCT. Tumor displacement in BH scans relative to the natural tumor path was measured relative to the EE 4DCT phase. Mean tumor motion (+/- 1 SD) during natural FB was 1 ± 1 mm, 2 ± 2 mm, and 6 ± 6 mm in medio-lateral, anterior-posterior, and cranio-caudal directions, respectively. Tumor position on BH CT scan was closer to EE than EI 4DCT phase for 35/53 patients (66%). Difference of BH tumor position vs. EE state was 4 ± 3 mm. Gross tumor displacements perpendicular to natural tumor path were as great as 11 mm (anterior-posterior) and were seen with or without the breathing monitoring device. Tumor position during BH CT may not accurately correspond to positions observed on FB 4DCT. Hence, accurate and custom 4D analysis for each individual patient is recommended for treatment planning, especially those involving BH acquisitions.

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