Journal List > J Lung Cancer > v.6(1) > 1050670

Song, Park, Yoon, Kim, Kim, Ahn, Shin, Lee, Park, and Choi: Assessment of Respiratory Tumor Movement using 4D Computed Tomography for Stereotactic Radiosurgery in Lung Tumor

Abstract

Purpose

To assess the respiratory tumor movement using 4D-CT (4-dimensio-nal computed tomography) for minimizing setup and target volume uncertainty of body-frame based stereotactic radiosurgery (SRS) in lung tumor.

Materials and Methods

Fifty-seven stereotactic radiation therapies with respiratory gating system in 44 patients (two targets in seven patients and three in three patients) were executed in Asan Medical Center from May 2005 to June 2006. We used respiratory gating system consisted of RPM (Real-time Positioning Management system, Varian, USA) and 4D-CT (GE healthcare, USA), if tumor movement was exceeding 5 mm by respiration on fluoroscopy. Accurate tumor movement on reconstructed 4D-CT image was determined for respiratory gated therapy. Respiratory gated therapy was done if tumor movement was exceeding 5 mm, and non-gated therapy was done if it was below 5 mm.

Results

Forty-five tumors were treated with supine position, and the other twelve were with prone position. Median tumor movement (3-dimensional) by respiration was 8.78±5.30 mm, and it was mostly affected by superior-inferior movement (8.53±5.23 mm). Tumor movements were different by tumor location, whether upper (5.38±2.85 mm) or lower (10.12±5.08 mm) lobe (p=0.015). Tumor movement was exceeding 5 mm in 27 (47.3%) tumors, and below 5 mm in 30 tumors in 4D-CT evaluation. Tumor movements on adopted respiratory gated phase were wholly below 5 mm, and its median value was 3.70±1.13 mm.

Conclusion

Assessment of respiratory tumor movement using 4D-CT and gating system was helpful for minimizing target volume uncertainty. As a result, imageguided radiation therapy could improve the treatment accuracy of high precision stereotactic radiosurgery.

References

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Fig. 1.
Treatment flow: gated radiation therapy.
jlc-6-24f1.tif
Table 1.
Patient Characteristics
Variables Number of patients (%)
Age  
 Median [Range] 59 [31–29]
ECOG  
 1 55 (96.5)
 2 2 (3.5)
Aim of SRS  
 Primary 26 (45.6)
 Metastatic 31 (54.4)
Location of tumor  
 Upper lobe 17 (29.8)
 Middle lobe 11 (19.3)
 Lower lobe 29 (50.9)
Patient’ s position  
 Supine 45 (78.9)
 Prone 12 (21.1)
Table 2.
Tumor Movement and Treatment Method
  Number of tumors Tumor movement (mm)(mean± SD) p value
Fluoroscopy (z-axis)      
Group 1* 5 3.40±2.70  
Group 2 25 9.28±2.81  
Group 3 27 13.06±5.79 <0.001§
4D-CT (3-dimension)    
Group 2 25 5.67±2.18  
Group 3 27 11.75±5.62  

* Tumor movement<5 mm on fluoroscopy, 4D-CT (?), no gated therapy,

Tumor movement ≥ 5 mm on fluoroscopy, but<5 mm on 4D-CT, no gated therapy,

Tumor movement≥5 mm on both fluoroscopy and 4D-CT, gated therapy,

§ one-way ANOVA test, SD: standard deviation

Table 3.
Tumor Movement with Full Respiration
  Mean± SD (mm) (Min.∼ Max.)
x-axis 1.01±1.26 (0.0∼5.9)
y-axis 1.40±1.55 (0.0∼8.1)
z-axis 8.53±5.23 (1.6∼22.9)
3-dimension 8.78±5.30 (1.1∼24.3)

SD: standard deviation

Table 4.
Tumor Movement by Location of Tumor with Full Respiration (3-dimension)
  Mean± SD (mm) p value
Upper lobe 5.38±2.85  
Middle lobe 10.01±6.81 0.015*
Lower lobe 10.12±5.08  

* one-way ANOVA test, SD: standard deviation

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