Pancreatic tumor motion on a single planning 4D-CT does not correlate with intrafraction tumor motion during treatment

A. Yuriko Minn, Devin Schellenberg, Peter Maxim, Yelin Suh, Stephen McKenna, Brett Cox, Sonja Dieterich, Lei Xing, Edward Graves, Karyn A. Goodman, Daniel Chang, Albert C. Koong

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

PURPOSE: To quantify pancreas tumor motion on both a planning 4D-CT and during a single fraction treatment using the CyberKnife linear accelerator and Synchrony respiratory tracking software, and to investigate whether a single 4D-CT study is reliable for determining radiation treatment margins for patients with locally advanced pancreas cancer. METHODS AND MATERIALS: Twenty patients underwent fiducial placement, biphasic pancreatic protocol CT scan and 4D-CT scan in the treatment position while free-breathing. Patients were then treated with a single 25 Gy fraction of stereotactic body radiotherapy. Predicted pancreas motion in the superior-inferior (SI), left-right (LR), and anterior-posterior (AP) directions was calculated from the maximum inspiration and maximum expiration 4D-CT scan. For CyberKnife treatments, mean respiratory cycle motion and maximum respiratory cycle motion was determined in the SI, LR, and AP directions. RESULTS: The range of centroid movement based on 4D-CT in the SI, LR, and AP directions were 0.9 to 28.8 mm, 0.1 to 13.7 mm, and 0.2 to 7.6 mm, respectively. During CyberKnife treatment, in the SI direction, the mean motion of the centroid ranged from 0.5 to 12.7 mm. In the LR direction, the mean motion range was 0.4 to 9.4 mm. In the AP direction, the mean motion range was 0.6 to 5.5 mm. The maximum range of movement (mean) during CyberKnife treatment in the SI, LR, and AP directions were 4.5 to 48.8 mm (mean 20.8 mm), 1.5 to 41.3 mm (mean 11.3 mm), and 1.6 to 68.1 mm (mean 13.4 mm), respectively. Neither the maximum or mean motion correlated with the 4D-CT movement. CONCLUSIONS: There is substantial respiratory associated motion of pancreatic tumors. The 4D-CT planning scans cannot accurately predict the movement of pancreatic tumors during actual treatment on CyberKnife.

Original languageEnglish (US)
Pages (from-to)364-368
Number of pages5
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume32
Issue number4
DOIs
StatePublished - Aug 2009
Externally publishedYes

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Four-Dimensional Computed Tomography
Neoplasms
Articular Range of Motion
Therapeutics
Pancreas
Particle Accelerators
Radiosurgery
Direction compound
Pancreatic Neoplasms
Respiration
Software
Radiation

Keywords

  • Cyberknife
  • IGRT
  • Pancreas cancer
  • Radiation therapy
  • SBRT

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Pancreatic tumor motion on a single planning 4D-CT does not correlate with intrafraction tumor motion during treatment. / Minn, A. Yuriko; Schellenberg, Devin; Maxim, Peter; Suh, Yelin; McKenna, Stephen; Cox, Brett; Dieterich, Sonja; Xing, Lei; Graves, Edward; Goodman, Karyn A.; Chang, Daniel; Koong, Albert C.

In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 32, No. 4, 08.2009, p. 364-368.

Research output: Contribution to journalArticle

Minn, AY, Schellenberg, D, Maxim, P, Suh, Y, McKenna, S, Cox, B, Dieterich, S, Xing, L, Graves, E, Goodman, KA, Chang, D & Koong, AC 2009, 'Pancreatic tumor motion on a single planning 4D-CT does not correlate with intrafraction tumor motion during treatment', American Journal of Clinical Oncology: Cancer Clinical Trials, vol. 32, no. 4, pp. 364-368. https://doi.org/10.1097/COC.0b013e31818da9e0
Minn, A. Yuriko ; Schellenberg, Devin ; Maxim, Peter ; Suh, Yelin ; McKenna, Stephen ; Cox, Brett ; Dieterich, Sonja ; Xing, Lei ; Graves, Edward ; Goodman, Karyn A. ; Chang, Daniel ; Koong, Albert C. / Pancreatic tumor motion on a single planning 4D-CT does not correlate with intrafraction tumor motion during treatment. In: American Journal of Clinical Oncology: Cancer Clinical Trials. 2009 ; Vol. 32, No. 4. pp. 364-368.
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abstract = "PURPOSE: To quantify pancreas tumor motion on both a planning 4D-CT and during a single fraction treatment using the CyberKnife linear accelerator and Synchrony respiratory tracking software, and to investigate whether a single 4D-CT study is reliable for determining radiation treatment margins for patients with locally advanced pancreas cancer. METHODS AND MATERIALS: Twenty patients underwent fiducial placement, biphasic pancreatic protocol CT scan and 4D-CT scan in the treatment position while free-breathing. Patients were then treated with a single 25 Gy fraction of stereotactic body radiotherapy. Predicted pancreas motion in the superior-inferior (SI), left-right (LR), and anterior-posterior (AP) directions was calculated from the maximum inspiration and maximum expiration 4D-CT scan. For CyberKnife treatments, mean respiratory cycle motion and maximum respiratory cycle motion was determined in the SI, LR, and AP directions. RESULTS: The range of centroid movement based on 4D-CT in the SI, LR, and AP directions were 0.9 to 28.8 mm, 0.1 to 13.7 mm, and 0.2 to 7.6 mm, respectively. During CyberKnife treatment, in the SI direction, the mean motion of the centroid ranged from 0.5 to 12.7 mm. In the LR direction, the mean motion range was 0.4 to 9.4 mm. In the AP direction, the mean motion range was 0.6 to 5.5 mm. The maximum range of movement (mean) during CyberKnife treatment in the SI, LR, and AP directions were 4.5 to 48.8 mm (mean 20.8 mm), 1.5 to 41.3 mm (mean 11.3 mm), and 1.6 to 68.1 mm (mean 13.4 mm), respectively. Neither the maximum or mean motion correlated with the 4D-CT movement. CONCLUSIONS: There is substantial respiratory associated motion of pancreatic tumors. The 4D-CT planning scans cannot accurately predict the movement of pancreatic tumors during actual treatment on CyberKnife.",
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T1 - Pancreatic tumor motion on a single planning 4D-CT does not correlate with intrafraction tumor motion during treatment

AU - Minn, A. Yuriko

AU - Schellenberg, Devin

AU - Maxim, Peter

AU - Suh, Yelin

AU - McKenna, Stephen

AU - Cox, Brett

AU - Dieterich, Sonja

AU - Xing, Lei

AU - Graves, Edward

AU - Goodman, Karyn A.

AU - Chang, Daniel

AU - Koong, Albert C.

PY - 2009/8

Y1 - 2009/8

N2 - PURPOSE: To quantify pancreas tumor motion on both a planning 4D-CT and during a single fraction treatment using the CyberKnife linear accelerator and Synchrony respiratory tracking software, and to investigate whether a single 4D-CT study is reliable for determining radiation treatment margins for patients with locally advanced pancreas cancer. METHODS AND MATERIALS: Twenty patients underwent fiducial placement, biphasic pancreatic protocol CT scan and 4D-CT scan in the treatment position while free-breathing. Patients were then treated with a single 25 Gy fraction of stereotactic body radiotherapy. Predicted pancreas motion in the superior-inferior (SI), left-right (LR), and anterior-posterior (AP) directions was calculated from the maximum inspiration and maximum expiration 4D-CT scan. For CyberKnife treatments, mean respiratory cycle motion and maximum respiratory cycle motion was determined in the SI, LR, and AP directions. RESULTS: The range of centroid movement based on 4D-CT in the SI, LR, and AP directions were 0.9 to 28.8 mm, 0.1 to 13.7 mm, and 0.2 to 7.6 mm, respectively. During CyberKnife treatment, in the SI direction, the mean motion of the centroid ranged from 0.5 to 12.7 mm. In the LR direction, the mean motion range was 0.4 to 9.4 mm. In the AP direction, the mean motion range was 0.6 to 5.5 mm. The maximum range of movement (mean) during CyberKnife treatment in the SI, LR, and AP directions were 4.5 to 48.8 mm (mean 20.8 mm), 1.5 to 41.3 mm (mean 11.3 mm), and 1.6 to 68.1 mm (mean 13.4 mm), respectively. Neither the maximum or mean motion correlated with the 4D-CT movement. CONCLUSIONS: There is substantial respiratory associated motion of pancreatic tumors. The 4D-CT planning scans cannot accurately predict the movement of pancreatic tumors during actual treatment on CyberKnife.

AB - PURPOSE: To quantify pancreas tumor motion on both a planning 4D-CT and during a single fraction treatment using the CyberKnife linear accelerator and Synchrony respiratory tracking software, and to investigate whether a single 4D-CT study is reliable for determining radiation treatment margins for patients with locally advanced pancreas cancer. METHODS AND MATERIALS: Twenty patients underwent fiducial placement, biphasic pancreatic protocol CT scan and 4D-CT scan in the treatment position while free-breathing. Patients were then treated with a single 25 Gy fraction of stereotactic body radiotherapy. Predicted pancreas motion in the superior-inferior (SI), left-right (LR), and anterior-posterior (AP) directions was calculated from the maximum inspiration and maximum expiration 4D-CT scan. For CyberKnife treatments, mean respiratory cycle motion and maximum respiratory cycle motion was determined in the SI, LR, and AP directions. RESULTS: The range of centroid movement based on 4D-CT in the SI, LR, and AP directions were 0.9 to 28.8 mm, 0.1 to 13.7 mm, and 0.2 to 7.6 mm, respectively. During CyberKnife treatment, in the SI direction, the mean motion of the centroid ranged from 0.5 to 12.7 mm. In the LR direction, the mean motion range was 0.4 to 9.4 mm. In the AP direction, the mean motion range was 0.6 to 5.5 mm. The maximum range of movement (mean) during CyberKnife treatment in the SI, LR, and AP directions were 4.5 to 48.8 mm (mean 20.8 mm), 1.5 to 41.3 mm (mean 11.3 mm), and 1.6 to 68.1 mm (mean 13.4 mm), respectively. Neither the maximum or mean motion correlated with the 4D-CT movement. CONCLUSIONS: There is substantial respiratory associated motion of pancreatic tumors. The 4D-CT planning scans cannot accurately predict the movement of pancreatic tumors during actual treatment on CyberKnife.

KW - Cyberknife

KW - IGRT

KW - Pancreas cancer

KW - Radiation therapy

KW - SBRT

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