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.
References
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Table 1.
Table 2.
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 |
Table 3.
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) |
Table 4.
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 |