Motion and dosimetric criteria for selecting gating technique for apical lung lesions in magnetic resonance guided radiotherapy

被引:1
作者
Galetto, Matteo [1 ,2 ]
Nardini, Matteo [2 ]
Capotosti, Amedeo [2 ]
Meffe, Guenda [2 ]
Cusumano, Davide [3 ]
Boldrini, Luca [2 ]
Chiloiro, Giuditta [2 ]
Romano, Angela [2 ]
Votta, Claudio [2 ]
Gambacorta, Maria A. [1 ,2 ]
Indovina, Luca [2 ]
Placidi, Lorenzo [2 ]
机构
[1] Univ Cattolica Sacro Cuore, Radiotherapy Dept, Rome, Italy
[2] Fdn Policlin Univ A Gemelli IRCCS, Radiotherapy Dept, Rome, Italy
[3] Fis Medicamater Olbia Hosp, Unita Operativa Semplice UOS, Olbia, Italy
来源
FRONTIERS IN ONCOLOGY | 2023年 / 13卷
关键词
MRgRT; gating; target motion; SBRT; lung; 4-DIMENSIONAL COMPUTED-TOMOGRAPHY; TUMOR MOTION; EARLY-STAGE; STEREOTACTIC RADIOTHERAPY; RESPIRATORY MOTION; CANCER; MANAGEMENT; STRATEGIES; VMAT;
D O I
10.3389/fonc.2023.1280845
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Introduction: Patients treatment compliance increases during free-breathing (FB) treatment, taking generally less time and fatigue with respect to deep inspiration breath-hold (DIBH). This study quantifies the gross target volume (GTV) motion on cine-MRI of apical lung lesions undergoing a SBRT in a MR-Linac and supports the patient specific treatment gating pre-selection.Material and methods: A total of 12 patients were retrospectively enrolled in this study. During simulation and treatment fractions, sagittal 0.35 T cine-MRI allows real-time GTV motion tracking. Cine-MRI has been exported, and an in-house developed MATLAB script performed image segmentation for measuring GTV centroid position on cine-MRI frames. Motion measurements were performed during the deep inspiration phase of DIBH patient and during all the session for FB patient. Treatment plans of FB patients were reoptimized using the same cost function, choosing the 3 mm GTV-PTV margin used for DIBH patients instead of the original 5 mm margin, comparing GTV and OARs DVH for the different TP.Results: GTV centroid motion is <2.2 mm in the antero-posterior and cranio-caudal direction in DIBH. For FB patients, GTV motion is lower than 1.7 mm, and motion during the treatment was always in agreement with the one measured during the simulation. No differences have been observed in GTV coverage between the TP with 3-mm and 5-mm margins. Using a 3-mm margin, the mean reduction in the chest wall and trachea-bronchus Dmax was 2.5 Gy and 3.0 Gy, respectively, and a reduction of 1.0 Gy, 0.6 Gy, and 2.3% in Dmax, Dmean, and V5Gy, respectively, of the homolateral lung and 1.7 Gy in the contralateral lung Dmax.Discussions: Cine-MRI allows to select FB lung patients when GTV motion is <2 mm. The use of narrower PTV margins reduces OARs dose and maintains target coverage.
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页数:10
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