Zhongde Mu1, Qi Wang2, Chang Guo2, Yong Feng2, Hongcheng Gu3, Zhenyu Zhai2, Jianfeng Wu2, Xia He4. 1. Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, People's Republic of China. mouzhongde@jszlyy.com.cn. 2. Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, People's Republic of China. 3. State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, People's Republic of China. 4. Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, People's Republic of China. hexiabm@163.com.
Abstract
BACKGROUND: Respiratory motion may compromise the dose delivery accuracy in liver stereotactic body radiation therapy (SBRT). Motion management can improve treatment delivery. However, external surrogate signal may be unstable and inaccurate. This study reports the first case of liver SBRT based on internal electromagnetic motion monitoring (Calypso, Varian Medical Systems, USA) in China. MATERIALS AND METHODS: The patient with a primary liver cancer was treated with respiratory-gated SBRT guided by three implanted electromagnetic transponders. The treatment was carried out in breath-hold end-exhale with beam-on when the centroid of the three transponders drifted within 5 mm (left-right (LR), anterior-posterior (AP) and cranio-caudal (CC) directions) from the planned position. The motion monitoring treatments were delivered in breath-hold end-exhale mode with the energy of 6 MV in FFF mode with 1200 monitor units (MU) per minute. For each fraction, QA results, intertransponder distances, geometric checks as well as tumor motion logs were explicitly recorded. RESULTS: Comparing with the plan data, distance variances between each two transponders were - 0.56 ± 0.32 mm, 0.17 ± 0.33 mm and - 0.82 ± 0.68 mm. Geometric residual, the pitch, roll and yaw angles were 0.48 ± 0.21 mm (threshold 2.0 mm), 2.17° ± 1.85° (threshold 10°), - 2.42° ± 1.51° (threshold 10°) and 1.67° ± 1.07° (threshold 10°), respectively. The delivery time of the five fields were 13.8 s, 13.1 s, 11.2 s, 11.6 s, and 11.6 s with the average value of 12.3 ± 1.1 s. Treatment duration of each fraction ranged from 6.2 to 21.4 min, with the average value of 11.3 ± 5.0 min. CONCLUSIONS: The first case of liver SBRT patient of China based on internal electromagnetic motion monitoring was performed. The system had a high tracking accuracy, and it did not delay the treatment time. In addition, the patient did not show any severe side effects except for grade I myelotoxicity. The internal electromagnetic motion monitoring system provides a real-time and direct way to track liver tumor targets.
BACKGROUND: Respiratory motion may compromise the dose delivery accuracy in liver stereotactic body radiation therapy (SBRT). Motion management can improve treatment delivery. However, external surrogate signal may be unstable and inaccurate. This study reports the first case of liver SBRT based on internal electromagnetic motion monitoring (Calypso, Varian Medical Systems, USA) in China. MATERIALS AND METHODS: The patient with a primary liver cancer was treated with respiratory-gated SBRT guided by three implanted electromagnetic transponders. The treatment was carried out in breath-hold end-exhale with beam-on when the centroid of the three transponders drifted within 5 mm (left-right (LR), anterior-posterior (AP) and cranio-caudal (CC) directions) from the planned position. The motion monitoring treatments were delivered in breath-hold end-exhale mode with the energy of 6 MV in FFF mode with 1200 monitor units (MU) per minute. For each fraction, QA results, intertransponder distances, geometric checks as well as tumor motion logs were explicitly recorded. RESULTS: Comparing with the plan data, distance variances between each two transponders were - 0.56 ± 0.32 mm, 0.17 ± 0.33 mm and - 0.82 ± 0.68 mm. Geometric residual, the pitch, roll and yaw angles were 0.48 ± 0.21 mm (threshold 2.0 mm), 2.17° ± 1.85° (threshold 10°), - 2.42° ± 1.51° (threshold 10°) and 1.67° ± 1.07° (threshold 10°), respectively. The delivery time of the five fields were 13.8 s, 13.1 s, 11.2 s, 11.6 s, and 11.6 s with the average value of 12.3 ± 1.1 s. Treatment duration of each fraction ranged from 6.2 to 21.4 min, with the average value of 11.3 ± 5.0 min. CONCLUSIONS: The first case of liver SBRT patient of China based on internal electromagnetic motion monitoring was performed. The system had a high tracking accuracy, and it did not delay the treatment time. In addition, the patient did not show any severe side effects except for grade I myelotoxicity. The internal electromagnetic motion monitoring system provides a real-time and direct way to track liver tumor targets.
Authors: Annemarie T Fernandes; Smith Apisarnthanarax; Lingshu Yin; Wei Zou; Mark Rosen; John P Plastaras; Edgar Ben-Josef; James M Metz; Boon-Keng Teo Journal: Int J Radiat Oncol Biol Phys Date: 2015-04-01 Impact factor: 7.038
Authors: Gordon O Schoenfeld; Robert J Amdur; Christopher G Morris; Jonathan G Li; Russell W Hinerman; William M Mendenhall Journal: Int J Radiat Oncol Biol Phys Date: 2007-12-31 Impact factor: 7.038
Authors: Joshua James; Ashley Cetnar; Neal E Dunlap; Corinna Huffaker; Vi Nhan Nguyen; Melissa Potts; Brian Wang Journal: Med Phys Date: 2016-06 Impact factor: 4.071
Authors: Juliet Brock; Helen A McNair; Niki Panakis; Richard Symonds-Tayler; Phil M Evans; Michael Brada Journal: Int J Radiat Oncol Biol Phys Date: 2010-08-26 Impact factor: 7.038
Authors: Anna Kirilova; Gina Lockwood; Perry Choi; Neelufer Bana; Masoom A Haider; Kristy K Brock; Cynthia Eccles; Laura A Dawson Journal: Int J Radiat Oncol Biol Phys Date: 2008-02-06 Impact factor: 7.038