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Impact of intra-fractional motion on dose distributions in lung IMRT

Published online by Cambridge University Press:  09 January 2020

Mikhail A. Chetvertkov ,
Oleg N. Vassiliev Open the ORCID record for Oleg N. Vassiliev [Opens in a new window] ,
Jinzhong Yang ,
He C. Wang ,
Amy Y. Liu ,
Zhongxing Liao  and
Radhe Mohan
Mikhail A. Chetvertkov
Affiliation:
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX77030, USA
Oleg N. Vassiliev*
Affiliation:
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX77030, USA
Jinzhong Yang
Affiliation:
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX77030, USA
He C. Wang
Affiliation:
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX77030, USA
Amy Y. Liu
Affiliation:
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX77030, USA
Zhongxing Liao
Affiliation:
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX77030, USA
Radhe Mohan
Affiliation:
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX77030, USA
*
Author for correspondence: Oleg N. Vassiliev, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX77030, USA. Tel: 713-745-7995; Fax: 713-563-6949; Email: onvassil@mdanderson.org
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Abstract

Aim:

To investigate the impact of intra-fractional motion on dose distribution in patients treated with intensity-modulated radiotherapy (IMRT) for lung cancer.

Materials and methods:

Twenty patients who had undergone IMRT for non-small cell lung cancer were selected for this retrospective study. For each patient, a four-dimensional computed tomography (CT) image set was acquired and clinical treatment plans were developed using the average CT. Dose distributions were then recalculated for each of the 10 phases of respiratory cycle and combined using deformable image registration to produce cumulative dose distributions that were compared with the clinical treatment plans.

Results:

Intra-fractional motion reduced planning target volume (PTV) coverage in all patients. The median reduction of PTV covered by the prescription isodose was 3·4%; D98 was reduced by 3·1 Gy. Changes in the mean lung dose were within ±0·7 Gy. V20 for the lung increased in most patients; the median increase was 1·6%. The dose to the spinal cord was unaffected by intra-fractional motion. The dose to the heart was slightly reduced in most patients. The median reduction in the mean heart dose was 0·22 Gy, and V30 was reduced by 2·5%. The maximum dose to the oesophagus was also reduced in most patients, by 0·74 Gy, whereas V50 did not change significantly. The median number of points in which dose differences exceeded 3%/3 mm was 6·2%.

Findings:

Intra-fractional anatomical changes reduce PTV coverage compared to the coverage predicted by clinical treatment planning systems that use the average CT for dose calculation. Doses to organs at risk were mostly over-predicted.

Keywords

dose accuracyintra-fractional motionlung IMRTPTV coverage
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 20 , Issue 1 , March 2021 , pp. 12 - 16
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Copyright
© The Authors, 2020. Published by Cambridge University Press

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Footnotes

a

Present address: Department of Radiation Oncology, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212, USA

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