PURPOSE: To report on a prospective clinical trial of the use of daily kilovoltage cone-beam computed tomography (CBCT) to evaluate the interfraction and residual error motion of patients undergoing intensity-modulated radiotherapy for head-and-neck cancer. METHODS AND MATERIALS: Patients were treated with intensity-modulated radiotherapy with an Elekta linear accelerator using a mounted CBCT scanner. CBCT was performed before every treatment, and translational (but not rotational) corrections were performed. At least once per week, a CBCT scan was obtained after intensity-modulated radiotherapy. Variations were measured in the medial-lateral, superoinferior, and anteroposterior dimensions, as well as in the rotation around these axes. RESULTS: A total of 28 consecutive patients (1,013 CBCT scans) were studied. The average interfraction shift was 1.4 +/- 1.4, 1.7 +/- 1.9, and 1.8 +/- 2.1 mm in the medial-lateral, superoinferior, and anteroposterior dimensions, respectively. The corresponding average residual error shifts were 0.7 +/- 0.8, 0.9 +/- 0.9, and 0.9 +/- 0.9 mm. These data indicate that in the absence of daily CBCT image-guided radiotherapy, a clinical target volume to planning target volume margin of 3.9, 4.1, and 4.9 mm is needed in the medial-lateral, superoinferior, and anteroposterior dimensions, respectively. With daily CBCT, corresponding margins of 1.6, 2.5, and 1.9 mm should be acceptable. Subgroup analyses showed that larynx cancers and/or intratreatment weight loss indicate a need for slightly larger clinical target volume to planning target volume margins. CONCLUSION: The results of our study have shown that image-guided radiotherapy using CBCT for head-and-neck cancer is effective. These data suggest it allows a reduction in the clinical target volume to planning target volume margins by about 50%, which could facilitate future studies of dose escalation and/or improved toxicity reduction. Caution is particularly warranted for cases in which the targets are mobile (e.g., the tongue).
PURPOSE: To report on a prospective clinical trial of the use of daily kilovoltage cone-beam computed tomography (CBCT) to evaluate the interfraction and residual error motion of patients undergoing intensity-modulated radiotherapy for head-and-neck cancer. METHODS AND MATERIALS: Patients were treated with intensity-modulated radiotherapy with an Elekta linear accelerator using a mounted CBCT scanner. CBCT was performed before every treatment, and translational (but not rotational) corrections were performed. At least once per week, a CBCT scan was obtained after intensity-modulated radiotherapy. Variations were measured in the medial-lateral, superoinferior, and anteroposterior dimensions, as well as in the rotation around these axes. RESULTS: A total of 28 consecutive patients (1,013 CBCT scans) were studied. The average interfraction shift was 1.4 +/- 1.4, 1.7 +/- 1.9, and 1.8 +/- 2.1 mm in the medial-lateral, superoinferior, and anteroposterior dimensions, respectively. The corresponding average residual error shifts were 0.7 +/- 0.8, 0.9 +/- 0.9, and 0.9 +/- 0.9 mm. These data indicate that in the absence of daily CBCT image-guided radiotherapy, a clinical target volume to planning target volume margin of 3.9, 4.1, and 4.9 mm is needed in the medial-lateral, superoinferior, and anteroposterior dimensions, respectively. With daily CBCT, corresponding margins of 1.6, 2.5, and 1.9 mm should be acceptable. Subgroup analyses showed that larynx cancers and/or intratreatment weight loss indicate a need for slightly larger clinical target volume to planning target volume margins. CONCLUSION: The results of our study have shown that image-guided radiotherapy using CBCT for head-and-neck cancer is effective. These data suggest it allows a reduction in the clinical target volume to planning target volume margins by about 50%, which could facilitate future studies of dose escalation and/or improved toxicity reduction. Caution is particularly warranted for cases in which the targets are mobile (e.g., the tongue).
Authors: J Boda-Heggemann; M Guckenberger; U Ganswindt; C Belka; H Wertz; M Blessing; F Wenz; M Fuss; F Lohr Journal: Radiologe Date: 2012-03 Impact factor: 0.635
Authors: Jeremy M Kilburn; Michael H Soike; John T Lucas; Diandra Ayala-Peacock; William Blackstock; Scott Isom; William T Kearns; William H Hinson; Antonius A Miller; William J Petty; Michael T Munley; James J Urbanic Journal: Pract Radiat Oncol Date: 2015-10-22
Authors: Adam D Yock; Adam S Garden; Laurence E Court; Beth M Beadle; Lifei Zhang; Lei Dong Journal: Int J Radiat Oncol Biol Phys Date: 2013-07-29 Impact factor: 7.038
Authors: Xiao Han; Erik Pearson; Charles Pelizzari; Hania Al-Hallaq; Emil Y Sidky; Junguo Bian; Xiaochuan Pan Journal: Phys Med Biol Date: 2015-05-28 Impact factor: 3.609
Authors: Benjamin S Rosen; Peter G Hawkins; Daniel F Polan; James M Balter; Kristy K Brock; Justin D Kamp; Christina M Lockhart; Avraham Eisbruch; Michelle L Mierzwa; Randall K Ten Haken; Issam El Naqa Journal: Int J Radiat Oncol Biol Phys Date: 2018-07-10 Impact factor: 7.038