Implications of free breathing motion assessed by 4D-computed tomography on the delivered dose in radiotherapy for esophageal cancer

Duma MN, Berndt J, Rondak IC, Devecka M, Wilkens JJ, Geinitz H, Combs SE, Oechsner M (2015)

Publication Type: Journal article

Publication year: 2015

Journal

Medical Dosimetry Elsevier

Book Volume: 40

Pages Range: 378-382

Journal Issue: 4

DOI: 10.1016/j.meddos.2015.07.002

Abstract

The aim of this study was to assess the effect of breathing motion on the delivered dose in esophageal cancer 3-dimensional (3D)-conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT). We assessed 16 patients with esophageal cancer. All patients underwent 4D-computed tomography (4D-CT) for treatment planning. For each of the analyzed patients, 1 3D-CRT, 1 IMRT, and 1 VMAT (RapidArc-RA) plan were calculated. Each of the 3 initial plans was recalculated on the 4D-CT (for the maximum free inspiration and maximum free expiration) to assess the effect of breathing motion. We assessed the minimum dose (Dmin) and mean dose (Dmean) to the esophagus within the planning target volume, the volume changes of the lungs, the Dmean and the total lung volume receiving at least 40 Gy (V40), and the V30, V20, V10, and V5. For the heart we assessed the Dmean and the V25. Over all techniques and all patients the change in Dmean as compared with the planned Dmean (planning CT [PCT]) to the esophagus was 0.48% in maximum free inspiration (CT_insp) and 0.55% in maximum free expiration (CT_exp). The Dmin CT_insp change was 0.86% and CT_exp change was 0.89%. The Dmean change of the lungs (heart) was in CT_insp 1.95% (2.89%) and 3.88% (2.38%) in CT_exp. In all, 4 patients had a clinically relevant change of the dose (≥ 5% Dmean to the heart and the lungs) between inspiration and expiration. These patients had a very cranially or caudally situated tumor. There are no relevant differences in the delivered dose to the regions of interest among the 3 techniques. Breathing motion management could be considered to achieve a better sparing of the lungs or heart in patients with cranially or caudally situated tumors.

Involved external institutions

Technische Universität München (TUM) DE Germany (DE) Ordensklinikum Linz GmbH Barmherzige Schwestern AT Austria (AT)

How to cite

APA:

Duma, M.N., Berndt, J., Rondak, I.-C., Devecka, M., Wilkens, J.J., Geinitz, H.,... Oechsner, M. (2015). Implications of free breathing motion assessed by 4D-computed tomography on the delivered dose in radiotherapy for esophageal cancer. Medical Dosimetry, 40(4), 378-382. https://doi.org/10.1016/j.meddos.2015.07.002

MLA:

Duma, Marciana Nona, et al. "Implications of free breathing motion assessed by 4D-computed tomography on the delivered dose in radiotherapy for esophageal cancer." Medical Dosimetry 40.4 (2015): 378-382.

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