Respiratory Motion Changes of Lung Tumors Over the Course of Radiation Therapy Based on Respiration-Correlated Four-Dimensional Computed Tomography Scans

Kristin J. Redmond, Danny Y. Song, Jana L. Fox, Jessica Zhou, C. Nicole Rosenzweig, Eric Ford

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Purpose: To determine whether lung tumor respiratory excursion at simulation is predictive of excursion during radiation and whether phase offsets between tumor and surrogate markers are constant throughout treatment. Methods and Materials: Respiration-correlated CT scans and two rescans (using a Brilliance Big Bore spiral CT simulator; Philips, Inc.) were obtained from 20 patients at simulation. Gross tumor volume (GTV) was contoured on 10 phases of the respiratory cycle, and excursions were calculated. Diaphragm and xyphoid motion were quantified. Phase offsets, ΔΦ, were calculated for patients with a GTV motion of >3 mm. Interfraction differences in excursions between simulation and rescans and magnitudes of variation in phase offset between fractions were evaluated. Results: Mean GTV excursions at simulation in superior-inferior, anterior-posterior, and medial-lateral directions were 0.67, 0.29, and 0.21 cm, respectively. The magnitude of superior-inferior GTV excursion correlated with tumor location (upper vs. lower lobe, p = 0.011). GTV excursions between simulation and rescan 1 (p = 0.115) and between simulation and rescan 2 (p = 0.071) were stable. Fourteen patients were analyzed for variations in phase offsets. GTV-xyphoid phase offset changed significantly between simulation and rescan 1 (p = 0.007) and simulation and rescan 2 (p = 0.008), with mean ΔΦ values of 13.2% (rescan 1) and 14.3% (rescan 2). Xyphoid-diaphragm offset changed between simulation and rescan 1 (p = 0.004) and between simulation and rescan 2 (p = 0.012), with mean ΔΦ values of 14.5% (rescan 1) and 7.6% (rescan 2). Conclusions: Interfraction consistency in tumor excursion suggests tumor excursion at simulation may direct therapy. Significant variations in phase lag between GTV and other anatomic structures throughout treatment have important implications for techniques that rely on surrogate structures to predict tumor motion.

Original languageEnglish (US)
Pages (from-to)1605-1612
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume75
Issue number5
DOIs
StatePublished - Dec 1 2009
Externally publishedYes

Fingerprint

Four-Dimensional Computed Tomography
respiration
Tumor Burden
lungs
radiation therapy
Respiration
Radiotherapy
tumors
tomography
Lung
Neoplasms
simulation
Diaphragm
Patient Simulation
diaphragms
Spiral Computed Tomography
Tumor Biomarkers
Therapeutics
Biomarkers
Radiation

Keywords

  • Lung tumor motion
  • Respiration-correlated 4D-CT
  • Respiratory gating
  • Respiratory tracking

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Respiratory Motion Changes of Lung Tumors Over the Course of Radiation Therapy Based on Respiration-Correlated Four-Dimensional Computed Tomography Scans. / Redmond, Kristin J.; Song, Danny Y.; Fox, Jana L.; Zhou, Jessica; Rosenzweig, C. Nicole; Ford, Eric.

In: International Journal of Radiation Oncology Biology Physics, Vol. 75, No. 5, 01.12.2009, p. 1605-1612.

Research output: Contribution to journalArticle

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abstract = "Purpose: To determine whether lung tumor respiratory excursion at simulation is predictive of excursion during radiation and whether phase offsets between tumor and surrogate markers are constant throughout treatment. Methods and Materials: Respiration-correlated CT scans and two rescans (using a Brilliance Big Bore spiral CT simulator; Philips, Inc.) were obtained from 20 patients at simulation. Gross tumor volume (GTV) was contoured on 10 phases of the respiratory cycle, and excursions were calculated. Diaphragm and xyphoid motion were quantified. Phase offsets, ΔΦ, were calculated for patients with a GTV motion of >3 mm. Interfraction differences in excursions between simulation and rescans and magnitudes of variation in phase offset between fractions were evaluated. Results: Mean GTV excursions at simulation in superior-inferior, anterior-posterior, and medial-lateral directions were 0.67, 0.29, and 0.21 cm, respectively. The magnitude of superior-inferior GTV excursion correlated with tumor location (upper vs. lower lobe, p = 0.011). GTV excursions between simulation and rescan 1 (p = 0.115) and between simulation and rescan 2 (p = 0.071) were stable. Fourteen patients were analyzed for variations in phase offsets. GTV-xyphoid phase offset changed significantly between simulation and rescan 1 (p = 0.007) and simulation and rescan 2 (p = 0.008), with mean ΔΦ values of 13.2{\%} (rescan 1) and 14.3{\%} (rescan 2). Xyphoid-diaphragm offset changed between simulation and rescan 1 (p = 0.004) and between simulation and rescan 2 (p = 0.012), with mean ΔΦ values of 14.5{\%} (rescan 1) and 7.6{\%} (rescan 2). Conclusions: Interfraction consistency in tumor excursion suggests tumor excursion at simulation may direct therapy. Significant variations in phase lag between GTV and other anatomic structures throughout treatment have important implications for techniques that rely on surrogate structures to predict tumor motion.",
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T1 - Respiratory Motion Changes of Lung Tumors Over the Course of Radiation Therapy Based on Respiration-Correlated Four-Dimensional Computed Tomography Scans

AU - Redmond, Kristin J.

AU - Song, Danny Y.

AU - Fox, Jana L.

AU - Zhou, Jessica

AU - Rosenzweig, C. Nicole

AU - Ford, Eric

PY - 2009/12/1

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N2 - Purpose: To determine whether lung tumor respiratory excursion at simulation is predictive of excursion during radiation and whether phase offsets between tumor and surrogate markers are constant throughout treatment. Methods and Materials: Respiration-correlated CT scans and two rescans (using a Brilliance Big Bore spiral CT simulator; Philips, Inc.) were obtained from 20 patients at simulation. Gross tumor volume (GTV) was contoured on 10 phases of the respiratory cycle, and excursions were calculated. Diaphragm and xyphoid motion were quantified. Phase offsets, ΔΦ, were calculated for patients with a GTV motion of >3 mm. Interfraction differences in excursions between simulation and rescans and magnitudes of variation in phase offset between fractions were evaluated. Results: Mean GTV excursions at simulation in superior-inferior, anterior-posterior, and medial-lateral directions were 0.67, 0.29, and 0.21 cm, respectively. The magnitude of superior-inferior GTV excursion correlated with tumor location (upper vs. lower lobe, p = 0.011). GTV excursions between simulation and rescan 1 (p = 0.115) and between simulation and rescan 2 (p = 0.071) were stable. Fourteen patients were analyzed for variations in phase offsets. GTV-xyphoid phase offset changed significantly between simulation and rescan 1 (p = 0.007) and simulation and rescan 2 (p = 0.008), with mean ΔΦ values of 13.2% (rescan 1) and 14.3% (rescan 2). Xyphoid-diaphragm offset changed between simulation and rescan 1 (p = 0.004) and between simulation and rescan 2 (p = 0.012), with mean ΔΦ values of 14.5% (rescan 1) and 7.6% (rescan 2). Conclusions: Interfraction consistency in tumor excursion suggests tumor excursion at simulation may direct therapy. Significant variations in phase lag between GTV and other anatomic structures throughout treatment have important implications for techniques that rely on surrogate structures to predict tumor motion.

AB - Purpose: To determine whether lung tumor respiratory excursion at simulation is predictive of excursion during radiation and whether phase offsets between tumor and surrogate markers are constant throughout treatment. Methods and Materials: Respiration-correlated CT scans and two rescans (using a Brilliance Big Bore spiral CT simulator; Philips, Inc.) were obtained from 20 patients at simulation. Gross tumor volume (GTV) was contoured on 10 phases of the respiratory cycle, and excursions were calculated. Diaphragm and xyphoid motion were quantified. Phase offsets, ΔΦ, were calculated for patients with a GTV motion of >3 mm. Interfraction differences in excursions between simulation and rescans and magnitudes of variation in phase offset between fractions were evaluated. Results: Mean GTV excursions at simulation in superior-inferior, anterior-posterior, and medial-lateral directions were 0.67, 0.29, and 0.21 cm, respectively. The magnitude of superior-inferior GTV excursion correlated with tumor location (upper vs. lower lobe, p = 0.011). GTV excursions between simulation and rescan 1 (p = 0.115) and between simulation and rescan 2 (p = 0.071) were stable. Fourteen patients were analyzed for variations in phase offsets. GTV-xyphoid phase offset changed significantly between simulation and rescan 1 (p = 0.007) and simulation and rescan 2 (p = 0.008), with mean ΔΦ values of 13.2% (rescan 1) and 14.3% (rescan 2). Xyphoid-diaphragm offset changed between simulation and rescan 1 (p = 0.004) and between simulation and rescan 2 (p = 0.012), with mean ΔΦ values of 14.5% (rescan 1) and 7.6% (rescan 2). Conclusions: Interfraction consistency in tumor excursion suggests tumor excursion at simulation may direct therapy. Significant variations in phase lag between GTV and other anatomic structures throughout treatment have important implications for techniques that rely on surrogate structures to predict tumor motion.

KW - Lung tumor motion

KW - Respiration-correlated 4D-CT

KW - Respiratory gating

KW - Respiratory tracking

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