대한방사선치료학회지 (The Journal of Korean Society for Radiation Therapy)

대한방사선치료학회 (Korean Society for Radiation Therapy)
권호 표지

호흡 동조 췌장 암 용적 세기조절 회전 치료 시 Inter-fraction Intra-fraction 분석

Analysis of inter-fraction and intra-fraction errors during volumetric modulated arc therapy in Pancreas Ca

  • 조영필 (서울아산병원 방사선종양학과) ;
  • 서동린 (서울아산병원 방사선종양학과) ;
  • 홍택균 (서울아산병원 방사선종양학과) ;
  • 강태영 (서울아산병원 방사선종양학과) ;
  • 백금문 (서울아산병원 방사선종양학과) ;
  • 홍동기 (서울아산병원 방사선종양학과) ;
  • 윤인하 (서울아산병원 방사선종양학과) ;
  • 김진산 (서울아산병원 방사선종양학과)
  • Jo, Young Pil (Department of Radiation Oncology, Asan Medical Center) ;
  • Seo, Dong Rin (Department of Radiation Oncology, Asan Medical Center) ;
  • Hong, Taek Kyun (Department of Radiation Oncology, Asan Medical Center) ;
  • Kang, Tae Yeong (Department of Radiation Oncology, Asan Medical Center) ;
  • Beck, Geum Mun (Department of Radiation Oncology, Asan Medical Center) ;
  • Hong, Dong Ki (Department of Radiation Oncology, Asan Medical Center) ;
  • Yun, In Ha (Department of Radiation Oncology, Asan Medical Center) ;
  • Kim, Jin San (Department of Radiation Oncology, Asan Medical Center)
  • 투고 : 2014.09.30
  • 심사 : 2014.12.02
  • 발행 : 2014.12.30
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초록

목 적 : 췌장 환자 방사선 치료 중 기점(Fiducial) 대상 내부 및 외부 종양 움직임의 오차를 정량화 하고자 한다. 또한 cone beam computed tomography (CBCT) 를 기반으로 호흡 시 췌장의 움직임 분석하고자 한다. 대상 및 방법 : 용적 세기변조 회전조사 (V-MAT)를 적용, 정위적 방사선 치료를 국소 진행성 췌장암 환자 11명을 대상으로 하였다. CBCT 및 직교 투시이미지를 적용하여 기점(Fiducial Marker)의 Inter, intra-fraction 움직임 변화를 치료 전, 치료 진행 시 분석하였다. 결 과 : 치료 후 프로토콜을 오프라인 교정 프로토콜을 사용하여, CBCT 와 직교투시 간의 평균 오차(범위)는 0.0(-1.7~4.0), 0.3(-0.5~3.0) and 0.0(-4.1~6.6)mm 측방 (LR), 세로 (AP) 및 종 방향 (SI) 이였다. 무작위 Inter-fraction Setup 오차 결과는 -0.1, -2.3 and -1.1 mm: 95% Fiducial포함 마진은 각 9.9, 7.8, 12.5mm로 수식되었다. 결 론 : 위 분석으로 뼈 일치 정렬 후 잔류 불확실성이 있으며, SI 방향에 큰 임의의 움직임은 적합한 여백이 필요하다. 주변 내부 장기를 보호, 내부 장기 문제점을 최소화, 호흡편차를 고려, 치료 시 정기적으로 측정하여야 한다.

Purpose : To assess target motion during radiotherapy by quantifying daily setup errors and inter-fractional and intra-fractional movements of pancreatic fiducials. Materials and Methods : Eleven patients were treated via stereotactic body radiotherapy (SBRT) with volumetric modulated arc therapy. Bony setup errors were calculated using cone beam computed tomography (CBCT). Inter-fractional and intrafractional fiducial (seed) motion was determined via cone beam computed tomography (CBCT) projections and orthogonal fluoroscopy. Results : Using an off-line correction protocol, setup errors were 0.0 (-1.7-4.0), 0.3 (-0.5-3.0), and 0.0 (-4.1-6.6) mm for the left-right, anterior-posterior, and superior-inferior directions respectively. Random inter-fractional setup errors in the mean fiducial positions were -0.1, -1.1, and -2.3 mm respectively. Intra-fractional fiducial margins were 9.9, 7.8, and 12.5 mm, respectively. Conclusion : Online inter-fractional and intra-fractional corrections based on daily kV images and CBCT expedites SBRT of pancreatic cancer. Importantly, inter-fractional and intra-fractional motion needs to be measured regularly during treatment of pancreatic cancer to account for variations in patient respiration.

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참고문헌

  1. Jemel A, Siegel R, Ward E, et al. Cancer statistics 2008. CA Cancer J Clin 2008;58:71-96. https://doi.org/10.3322/CA.2007.0010
  2. Evans DB, Abbruzzese JL, Willett CG. Cancer of the pancreas. In: DeVita VT Jr., Hellman S, Rosenberg SA, editors. Cancer principles and practice of oncology. New York: Lippincott Williams & Wilkins; 2001. p. 1126-1161.
  3. Gastrointestinal Tumor Study Group. Treatment of locally unresectable carcinoma of the pancreas: Comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. J Natl Cancer Inst 1988;80:751-755. https://doi.org/10.1093/jnci/80.10.751
  4. Moertel CG, Frytak S, Hahn RG, et al. Therapy of locally unresectable pancreatic carcinoma: A randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5- fluorouracil. Cancer 1981;48:1705-1710. https://doi.org/10.1002/1097-0142(19811015)48:8<1705::AID-CNCR2820480803>3.0.CO;2-4
  5. Ben-Josef E, Shields AF, Vaishampayan U, et al. Intensitymodulated radiotherapy (IMRT) and concurrent capecitabine for pancreatic cancer. Int J Radiat Oncol Biol Phys 2004;59:454-459. https://doi.org/10.1016/j.ijrobp.2003.11.019
  6. Brown MW, Ning H, Arora B, et al. A dosimetric analysis of dose escalation using two intensitymodulated radiation therapy techniques in locally advanced pancreatic carcinoma. Int J Radiat Oncol Biol Phys 2006;65:274-283. https://doi.org/10.1016/j.ijrobp.2006.01.003
  7. Xing L, Thorndyke B, Schreibmann E, et al. Overview of image-guided radiation therapy. Med Dosim 2006;31:91-112. https://doi.org/10.1016/j.meddos.2005.12.004
  8. Murphy MJ, Martin D, Whyte R, et al. The effectiveness of breath-holding to stabilize lung and pancreas tumors during radiosurgery. Int J Radiat Oncol Biol Phys 2002;53:475-482. https://doi.org/10.1016/S0360-3016(01)02822-X
  9. Gierga DP, Chen GTY, Kung JH, et al. Quantification of respiration-induced abdominal tumor motion and its impact on IMRT dose distributions. Int J Radiat Oncol Biol Phys 2004;58:1584-1595. https://doi.org/10.1016/j.ijrobp.2003.09.077
  10. Minn AY, Schellenberg D, Maxim P, et al. Pancreatic tumor motion on a single planning 4D-CT does not correlate with intrafraction tumor motion during treatment. Am J Clin Oncol. In press. 2009, April 24. Epub ahead of print.
  11. Horst E, Micke O, Moustakis C, et al. Conformal therapy for pancreatic cancer: Variation of organ position due to gastrointestinal distention?- Implications for treatment planning. Radiology 2002;222:681-686. https://doi.org/10.1148/radiol.2223010639
  12. Schewe JE, Balter JM, Lam KL, ten Haken RK. Measurement of patient setup errors using port films and a computer-aided graphical alignment tool. Med Dosim 1996;21:87-104. https://doi.org/10.1016/0958-3947(95)02053-5
  13. Li XA, Qi XS, Pitterle M, et al. Interfractional variations in patient setup and anatomic change assessed by daily computed tomography. Int J Radiat Oncol Biol Phys 2007;68:581-591. https://doi.org/10.1016/j.ijrobp.2006.12.024
  14. Fuss M, Salter BJ, Cavanaugh SX, et al. Daily ultrasound-based image-guided targeting for radiotherapy of upper abdominal malignancies. Int J Radiat Oncol Biol Phys 2004;59:1245-1256. https://doi.org/10.1016/j.ijrobp.2003.12.030