Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-27T13:23:07.091Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of a reproducible breath hold technique for the SABR treatment of lower lobe lung tumours

Published online by Cambridge University Press:  07 March 2017

S. Barrett ,
A. Taylor  and
L. Rock
S. Barrett*
Affiliation:
Discipline of Radiation Therapy, Trinity College Dublin, University of Dublin, Dublin, Ireland
A. Taylor
Affiliation:
Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
L. Rock
Affiliation:
Radiation Oncology Department, Beacon Hospital Cancer Centre, Sandyford, Dublin, Ireland
*
Correspondence to: Sarah Barrett, Discipline of Radiation Therapy, Trinity Centre for Health Sciences, James’s Street, Dublin 8, Ireland. Tel: 0035 318 963 248. E-mail: barrets7@tcd.ie
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim

Deep inspiration breath hold (DIBH) is a method of motion management used in stereotactic ablative body radiotherapy (SABR) for lung tumours. An external gating block marker can be used as a tumour motion surrogate, however, inter-fraction gross target volume (GTV) displacement within DIBH occurs. This study measured this displacement during a reproducible breath hold regime. In addition, factors such as position of the gating block marker were analysed.

Methods and materials

A total of 121 cone beam computed tomography scans (CBCTs) from 22 patients who received DIBH SABR were retrospectively evaluated and the magnitude of inter-fraction GTV displacement was calculated for each fraction. This data was analysed to assess if any correlation existed between tumour displacement and variation in the gating block marker position on the patient, the amplitude of breath hold (BH) at computed tomography (CT), the amplitude of BH at treatment and the tumour location.

The measured tumour displacement was applied to the original planning CT to evaluate the dosimetric effect on surrounding organs at risk (OARs) using cumulative dose volume histograms (DVHs).

Results

BH amplitude was reproducible within 0·13±0·1 cm (mean±standard deviation). The magnitude of tumour displacement within BH ranged from 0 to 1·52 cm (0·41±0·28 cm). Displacement in the superior-inferior, anterior-posterior and left-right planes were 0·31±0·26 cm, 0·16±0·18 cm and 0·07±0·12 cm, respectively. No statistically significant correlation was detected between tumour displacement within DIBH and the factors investigated. The range of variation in OAR dose was −7·0 to +3·6 Gy with one statistically significant increase in OAR dose observed (oesophagus mean dose increasing by 0·16 Gy).

Findings

Reproducible BH was achievable across a range of patients. Inter-fraction GTV displacement measured 0·41±0·28 cm. Due to this low level of motion, the correction of soft tissue moves did not adversely affect OAR dose.

Keywords

deep inspiration breath holdinter-fraction motionlungOAR tolerancesstereotactic
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 3 , September 2017 , pp. 311 - 318
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Vansteenkiste, J, De Ruysscher, D, Eberhardt, W E E et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 (suppl 6): vi89–vi98 Google Scholar
2. Früh, M, De Ruysscher, D, Popat, S, Crinò, L, Peters, S, Felip, E. Small-cell lung cancer (SCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 (suppl 6): vi99–vi105 Google Scholar
3. Baumann, P, Nyman, J, Hoyer, M et al. Outcome in a prospective phase II trial of medically inoperable stage I non-small-cell lung cancer patients treated with stereotactic body radiotherapy. J Clin Oncol 2009; 27 (20): 3290–3296 Google Scholar
4. Wulf, J, Haedinger, U, Oppitz, U, Thiele, W, Mueller, G, Flentje, M. Stereotactic radiotherapy for primary lung cancer and pulmonary metastases: a noninvasive treatment approach in medically inoperable patients. Int J Radiat Oncol Biol Phys 2004; 60 (1): 186–196 Google Scholar
5. Kontrisova, K, Stock, M, Dieckmann, K, Bogner, J, Pötter, R, Georg, D. Dosimetric comparison of stereotactic body radiotherapy in different respiration conditions: a modeling study. Radiother Oncol 2006; 81: 97–104 Google Scholar
6. Zhang, G, Yu, H, Stevens, C et al. Motion management in stereotactic body radiotherapy. J Nucl Med Radiat Ther 2012; (suppl 6): 12 Google Scholar
7. Kimura, T, Murakami, Y, Kenjo, M et al. Interbreath-hold reproducibility of lung tumour position and reduction of the internal target volume using a voluntary breath-hold method with spirometer during stereotactic radiotherapy for lung tumours. Brit J Radiol 2007; 80: 355–361 Google Scholar
8. Peng, Y, Vedam, S, Chang, J Y et al. Implementation of feedback-guided voluntary breath-hold gating for cone beam ct-based stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 2011; 80 (3): 909–917 Google Scholar
9. Berson, A M, Emery, R, Rodriguez, L et al. Clinical experience using respiratory gated radiation therapy: comparison of free-breathing and breath-hold techniques. Int J Radiat Oncol Biol Phys 2004; 60 (2): 419–426 CrossRefGoogle ScholarPubMed
10. Peng, Y, Sadagopan, S, Vedam, S et al. The impact of daily tumor shift on normal tissue sparing and dose coverage for BH stereotactic body radiotherapy (SBRT) of lung tumor (abstract). Int J Radiat Oncol Biol Phys 2010; 78 (suppl 3): 769–770 Google Scholar
11. Glide-Hurst, C, Gopan, E, Hugo, D. Anatomic and pathologic variability during radiotherapy for a hybrid active breath-hold gating technique. Int J Radiat Oncol Biol Phys 2010; 77 (3): 910–917 Google Scholar
12. Rosenzweig, K E, Hanley, J, Mah, D et al. The deep inspiration breath-hold technique in the treatment of inoperable non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2000; 48 (1): 81–87 Google Scholar
13. Renming, Z, Wang, J, Zhou, L et al. Implementation of single-breath-hold cone beam CT guided hypofraction radiotherapy for lung cancer. Radiat Oncol 2014; 9 (1): 1–17 Google Scholar
14. Grégoire, V, Mackie, T R. State of the art on dose prescription, reporting and recording in intensity-modulated radiation therapy (ICRU report No. 83). Cancer/Radiothérapie 2011; 15 (6–7): 555–559 Google Scholar
15. van Rooijen, D, van Wieringen, N, Stippel, G, Crezee, J, Koning, C, Bel, A. Potential benefit of online dose recalculation for stereotactic lung irradiation in patients with non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2012; 83: e557–e562 Google Scholar