open access

Vol 21, No 3 (2016)
Original research articles
Published online: 2016-05-01
Submitted: 2015-07-22
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A single reference measurement can predict liver tumor motion during respiration

Jakub Cvek, Lukas Knybel, Lukas Molenda, Bretislav Otahal, Tomas Jonszta, Daniel Czerny, David Feltl
DOI: 10.1016/j.rpor.2015.11.003
·
Rep Pract Oncol Radiother 2016;21(3):278-283.

open access

Vol 21, No 3 (2016)
Original research articles
Published online: 2016-05-01
Submitted: 2015-07-22

Abstract

Aim

To evaluate liver tumor motion and how well reference measurement predicts motion during treatment.

Material and methods

This retrospective study included 20 patients with colorectal cancer that had metastasized to the liver who were treated with stereotactic ablative radiotherapy. An online respiratory tumor tracking system was used. Tumor motion amplitudes in the superior-inferior (SI), latero-lateral (LL), and anterior-posterior (AP) directions were collected to generate patient-specific margins. Reference margins were generated as the mean motion and 95th percentile of motion from measurements recorded for different lengths of time (1, 3, and 5[[ce:hsp sp="0.25"/]]min). We analyzed the predictability of tumor motion in each axis, based on the reference measurement and intra-/interfraction motions.

Results

About 96,000 amplitudes were analyzed. The mean tumor motions were 9.9[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]4.2[[ce:hsp sp="0.25"/]]mm, 2.6[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.8[[ce:hsp sp="0.25"/]]mm, and 4.5[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]1.8[[ce:hsp sp="0.25"/]]mm in the SI, LL, and AP directions, respectively. The intrafraction variations were 3.5[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]1.8[[ce:hsp sp="0.25"/]]mm, 0.63[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.35[[ce:hsp sp="0.25"/]]mm, and 1.4[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.65[[ce:hsp sp="0.25"/]]mm for the SI, LL, and AP directions, respectively. The interfraction motion variations were 1.32[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.79[[ce:hsp sp="0.25"/]]mm, 0.31[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.23[[ce:hsp sp="0.25"/]]mm, and 0.68[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.62[[ce:hsp sp="0.25"/]]mm for the SI, LL, and AP directions, respectively. The Pearson's correlation coefficients for margins based on the reference measurement (mean motion or 95th percentile) and margins covering 95% of the motion during the whole treatment were 0.8–0.91, 0.57–0.7, and 0.77–0.82 in the SI, LL, and AP directions, respectively.

Conclusion

Liver tumor motion in the SI direction can be adequately represented by the mean tumor motion amplitude generated from a single 1[[ce:hsp sp="0.25"/]]min reference measurement. Longer reference measurements did not improve results for patients who were well-educated about the importance of regular breathing. Although the study was based on tumor tracking data, the results are useful for ITV delineation when tumor tracking is not available.

Abstract

Aim

To evaluate liver tumor motion and how well reference measurement predicts motion during treatment.

Material and methods

This retrospective study included 20 patients with colorectal cancer that had metastasized to the liver who were treated with stereotactic ablative radiotherapy. An online respiratory tumor tracking system was used. Tumor motion amplitudes in the superior-inferior (SI), latero-lateral (LL), and anterior-posterior (AP) directions were collected to generate patient-specific margins. Reference margins were generated as the mean motion and 95th percentile of motion from measurements recorded for different lengths of time (1, 3, and 5[[ce:hsp sp="0.25"/]]min). We analyzed the predictability of tumor motion in each axis, based on the reference measurement and intra-/interfraction motions.

Results

About 96,000 amplitudes were analyzed. The mean tumor motions were 9.9[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]4.2[[ce:hsp sp="0.25"/]]mm, 2.6[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.8[[ce:hsp sp="0.25"/]]mm, and 4.5[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]1.8[[ce:hsp sp="0.25"/]]mm in the SI, LL, and AP directions, respectively. The intrafraction variations were 3.5[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]1.8[[ce:hsp sp="0.25"/]]mm, 0.63[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.35[[ce:hsp sp="0.25"/]]mm, and 1.4[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.65[[ce:hsp sp="0.25"/]]mm for the SI, LL, and AP directions, respectively. The interfraction motion variations were 1.32[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.79[[ce:hsp sp="0.25"/]]mm, 0.31[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.23[[ce:hsp sp="0.25"/]]mm, and 0.68[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.62[[ce:hsp sp="0.25"/]]mm for the SI, LL, and AP directions, respectively. The Pearson's correlation coefficients for margins based on the reference measurement (mean motion or 95th percentile) and margins covering 95% of the motion during the whole treatment were 0.8–0.91, 0.57–0.7, and 0.77–0.82 in the SI, LL, and AP directions, respectively.

Conclusion

Liver tumor motion in the SI direction can be adequately represented by the mean tumor motion amplitude generated from a single 1[[ce:hsp sp="0.25"/]]min reference measurement. Longer reference measurements did not improve results for patients who were well-educated about the importance of regular breathing. Although the study was based on tumor tracking data, the results are useful for ITV delineation when tumor tracking is not available.

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Keywords

Liver cancer; Tumor motion; Internal target volume

About this article
Title

A single reference measurement can predict liver tumor motion during respiration

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 21, No 3 (2016)

Pages

278-283

Published online

2016-05-01

DOI

10.1016/j.rpor.2015.11.003

Bibliographic record

Rep Pract Oncol Radiother 2016;21(3):278-283.

Keywords

Liver cancer
Tumor motion
Internal target volume

Authors

Jakub Cvek
Lukas Knybel
Lukas Molenda
Bretislav Otahal
Tomas Jonszta
Daniel Czerny
David Feltl

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