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Geometric uncertainties in voluntary deep inspiration breath hold radiotherapy for locally advanced lung cancer

Josipovic, Mirjana ; Fredberg Persson, Gitte ; Dueck, Jenny LU ; Bangsgaard, Jens Peter ; Westman, Gunnar ; Specht, Lena and Aznar, Marianne Camille (2016) In Radiotherapy and Oncology 118(3). p.510-514
Abstract
Background and purpose
Deep inspiration breath hold (DIBH) increases lung volume and can potentially reduce treatment-related toxicity in locally advanced lung cancer. We estimated geometric uncertainties in visually guided voluntary DIBH and derived the appropriate treatment margins for different image-guidance strategies.
Material and methods
Seventeen patients were included prospectively. An optical marker-based respiratory monitoring with visual guidance enabled comfortable DIBHs, adjusted to each patient’s performance. All patients had three consecutive DIBH CTs at each of the treatment fractions 2, 16 and 31. DIBH reproducibility was evaluated as inter- and intra-fractional variations in lung volume, tumour position and... (More)
Background and purpose
Deep inspiration breath hold (DIBH) increases lung volume and can potentially reduce treatment-related toxicity in locally advanced lung cancer. We estimated geometric uncertainties in visually guided voluntary DIBH and derived the appropriate treatment margins for different image-guidance strategies.
Material and methods
Seventeen patients were included prospectively. An optical marker-based respiratory monitoring with visual guidance enabled comfortable DIBHs, adjusted to each patient’s performance. All patients had three consecutive DIBH CTs at each of the treatment fractions 2, 16 and 31. DIBH reproducibility was evaluated as inter- and intra-fractional variations in lung volume, tumour position and differential motion between primary tumour and mediastinal lymph nodes.
Results
Lung volume increased by median 60% in DIBH. Inter- and intra-fractional lung volume variations were median 2.1% and 1.1%, respectively.
Inter- and intra-fractional uncertainties in 3D tumour position were 4.8 ± 2.8 mm and 1.7 ± 1.4 mm (mean ± SD). Inter- and intra-fractional differential motion was 4.8 ± 3.3 mm and 0.0 ± 1.1 mm.
Conclusions
For single targets, visually guided voluntary DIBH radiotherapy is highly reproducible provided an image-guidance strategy with tumour registration is performed. If the primary tumour is separated from the mediastinal lymph nodes, inter-fractional differential motion remains a challenge and margins must be adapted to reflect the image registration strategy. (Less)
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author
; ; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
in
Radiotherapy and Oncology
volume
118
issue
3
pages
5 pages
publisher
Elsevier
external identifiers
  • scopus:84949504063
ISSN
1879-0887
DOI
10.1016/j.radonc.2015.11.004
language
English
LU publication?
no
id
2d5f9e75-d971-497b-8305-482a20b8334a
date added to LUP
2023-06-08 20:09:17
date last changed
2023-06-09 07:19:39
@article{2d5f9e75-d971-497b-8305-482a20b8334a,
  abstract     = {{Background and purpose<br/>Deep inspiration breath hold (DIBH) increases lung volume and can potentially reduce treatment-related toxicity in locally advanced lung cancer. We estimated geometric uncertainties in visually guided voluntary DIBH and derived the appropriate treatment margins for different image-guidance strategies.<br/>Material and methods<br/>Seventeen patients were included prospectively. An optical marker-based respiratory monitoring with visual guidance enabled comfortable DIBHs, adjusted to each patient’s performance. All patients had three consecutive DIBH CTs at each of the treatment fractions 2, 16 and 31. DIBH reproducibility was evaluated as inter- and intra-fractional variations in lung volume, tumour position and differential motion between primary tumour and mediastinal lymph nodes.<br/>Results<br/>Lung volume increased by median 60% in DIBH. Inter- and intra-fractional lung volume variations were median 2.1% and 1.1%, respectively.<br/>Inter- and intra-fractional uncertainties in 3D tumour position were 4.8 ± 2.8 mm and 1.7 ± 1.4 mm (mean ± SD). Inter- and intra-fractional differential motion was 4.8 ± 3.3 mm and 0.0 ± 1.1 mm.<br/>Conclusions<br/>For single targets, visually guided voluntary DIBH radiotherapy is highly reproducible provided an image-guidance strategy with tumour registration is performed. If the primary tumour is separated from the mediastinal lymph nodes, inter-fractional differential motion remains a challenge and margins must be adapted to reflect the image registration strategy.}},
  author       = {{Josipovic, Mirjana and Fredberg Persson, Gitte and Dueck, Jenny and Bangsgaard, Jens Peter and Westman, Gunnar and Specht, Lena and Aznar, Marianne Camille}},
  issn         = {{1879-0887}},
  language     = {{eng}},
  month        = {{03}},
  number       = {{3}},
  pages        = {{510--514}},
  publisher    = {{Elsevier}},
  series       = {{Radiotherapy and Oncology}},
  title        = {{Geometric uncertainties in voluntary deep inspiration breath hold radiotherapy for locally advanced lung cancer}},
  url          = {{http://dx.doi.org/10.1016/j.radonc.2015.11.004}},
  doi          = {{10.1016/j.radonc.2015.11.004}},
  volume       = {{118}},
  year         = {{2016}},
}