open access

Vol 22, No 2 (2017)
Special Issue Papers
Published online: 2017-03-01
Submitted: 2016-02-04
Get Citation

Imaged-guided liver stereotactic body radiotherapy using VMAT and real-time adaptive tumor gating. Concerns about technique and preliminary clinical results

Carmen Llacer-Moscardo, Olivier Riou, David Azria, Ludovic Bedos, Norbert Ailleres, Francois Quenet, Philippe Rouanet, Marc Ychou, Pascal Fenoglietto
DOI: 10.1016/j.rpor.2016.06.004
·
Rep Pract Oncol Radiother 2017;22(2):141-149.

open access

Vol 22, No 2 (2017)
Special Issue Papers
Published online: 2017-03-01
Submitted: 2016-02-04

Abstract

Background

Motion management is a major challenge in abdominal SBRT. We present our study of SBRT for liver tumors using intrafraction motion review (IMR) allowing simultaneous KV information and MV delivery to synchronize the beam during gated RapidArc treatment.

Materials and methods

Between May 2012 and March 2015, 41 patients were treated by liver SBRT using gated RapidArc technique in a Varian Novalis Truebeam STx linear accelerator. PTV was created by expanding 5[[ce:hsp sp="0.25"/]]mm from the ITV. Dose prescription ranged from 40 to 50[[ce:hsp sp="0.25"/]]Gy in 5–10 fractions. The prescribed dose and fractionation were chosen depending on hepatic function and dosimetric results. Thirty-four patients with a minimal follow-up of six months were analyzed for local control and toxicity. Accuracy for tumor repositioning was evaluated for the first ten patients.

Results

With a median follow-up of 13 months, the treatment was well tolerated and no patient presented RILD, perforation or gastrointestinal bleeding. Acute toxicity was found in 3 patients with G1 abdominal pain, 2 with G1 nausea, 10 with G1 asthenia and 1 with G2 asthenia. 6 patients presented asymptomatic transitory perturbation of liver enzymes.

In-field local control was 90.3% with 7 complete responses, 14 partial responses and 7 stabilisations. 3 patients evolved “in field”. 12 patients had an intrahepatic progression “out of field”.

Mean intrafraction deviation of fiducials in the craneo-caudal direction was 0.91[[ce:hsp sp="0.25"/]]mm (0–6[[ce:hsp sp="0.25"/]]mm).

Conclusion

The clinical tolerance and oncological outcomes were favorable when using image-guided liver SBRT with real-time adaptive tumor gating.

Abstract

Background

Motion management is a major challenge in abdominal SBRT. We present our study of SBRT for liver tumors using intrafraction motion review (IMR) allowing simultaneous KV information and MV delivery to synchronize the beam during gated RapidArc treatment.

Materials and methods

Between May 2012 and March 2015, 41 patients were treated by liver SBRT using gated RapidArc technique in a Varian Novalis Truebeam STx linear accelerator. PTV was created by expanding 5[[ce:hsp sp="0.25"/]]mm from the ITV. Dose prescription ranged from 40 to 50[[ce:hsp sp="0.25"/]]Gy in 5–10 fractions. The prescribed dose and fractionation were chosen depending on hepatic function and dosimetric results. Thirty-four patients with a minimal follow-up of six months were analyzed for local control and toxicity. Accuracy for tumor repositioning was evaluated for the first ten patients.

Results

With a median follow-up of 13 months, the treatment was well tolerated and no patient presented RILD, perforation or gastrointestinal bleeding. Acute toxicity was found in 3 patients with G1 abdominal pain, 2 with G1 nausea, 10 with G1 asthenia and 1 with G2 asthenia. 6 patients presented asymptomatic transitory perturbation of liver enzymes.

In-field local control was 90.3% with 7 complete responses, 14 partial responses and 7 stabilisations. 3 patients evolved “in field”. 12 patients had an intrahepatic progression “out of field”.

Mean intrafraction deviation of fiducials in the craneo-caudal direction was 0.91[[ce:hsp sp="0.25"/]]mm (0–6[[ce:hsp sp="0.25"/]]mm).

Conclusion

The clinical tolerance and oncological outcomes were favorable when using image-guided liver SBRT with real-time adaptive tumor gating.

Get Citation

Keywords

Liver SBRT; Adaptative tumor gating; VMAT

About this article
Title

Imaged-guided liver stereotactic body radiotherapy using VMAT and real-time adaptive tumor gating. Concerns about technique and preliminary clinical results

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 22, No 2 (2017)

Pages

141-149

Published online

2017-03-01

DOI

10.1016/j.rpor.2016.06.004

Bibliographic record

Rep Pract Oncol Radiother 2017;22(2):141-149.

Keywords

Liver SBRT
Adaptative tumor gating
VMAT

Authors

Carmen Llacer-Moscardo
Olivier Riou
David Azria
Ludovic Bedos
Norbert Ailleres
Francois Quenet
Philippe Rouanet
Marc Ychou
Pascal Fenoglietto

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: journals@viamedica.pl