Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Radiation Oncology
Published in: Radiation Oncology 1/2011

Open Access 01-12-2011 | Methodology

Breathing adapted radiotherapy: a 4D gating software for lung cancer

Authors: Nicolas Peguret, Jacqueline Vock, Vincent Vinh-Hung, Pascal Fenoglietto, David Azria, Habib Zaidi, Michael Wissmeyer, Osman Ratib, Raymond Miralbell

Published in: Radiation Oncology | Issue 1/2011

Login to get access

Abstract

Purpose

Physiological respiratory motion of tumors growing in the lung can be corrected with respiratory gating when treated with radiotherapy (RT). The optimal respiratory phase for beam-on may be assessed with a respiratory phase optimizer (RPO), a 4D image processing software developed with this purpose.

Methods and Materials

Fourteen patients with lung cancer were included in the study. Every patient underwent a 4D-CT providing ten datasets of ten phases of the respiratory cycle (0-100% of the cycle). We defined two morphological parameters for comparison of 4D-CT images in different respiratory phases: tumor-volume to lung-volume ratio and tumor-to-spinal cord distance. The RPO automatized the calculations (200 per patient) of these parameters for each phase of the respiratory cycle allowing to determine the optimal interval for RT.

Results

Lower lobe lung tumors not attached to the diaphragm presented with the largest motion with breathing. Maximum inspiration was considered the optimal phase for treatment in 4 patients (28.6%). In 7 patients (50%), however, the RPO showed a most favorable volumetric and spatial configuration in phases other than maximum inspiration. In 2 cases (14.4%) the RPO showed no benefit from gating. This tool was not conclusive in only one case.

Conclusions

The RPO software presented in this study can help to determine the optimal respiratory phase for gated RT based on a few simple morphological parameters. Easy to apply in daily routine, it may be a useful tool for selecting patients who might benefit from breathing adapted RT.
Appendix
Available only for authorised users
Literature
1.
Perez CA, Bauer M, Edelstein S, Gillespie BW, Birch R: Impact of tumor control on survival in carcinoma of the lung treated with irradiation. Int J Radiat Oncol Biol Phys 1986,12(4):539-47. 10.1016/0360-3016(86)90061-1CrossRefPubMed
2.
Rosenman JG, Halle JS, Socinski MA, Deschesne K, Moore DT, Johnson H, Fraser R, Morris DE: High-dose conformal radiotherapy for treatment of stage IIIA/IIIB non-small-cell lung cancer: technical issues and results of a phase I/II trial. Int J Radiat Oncol Biol Phys 2002,54(2):348-56. 10.1016/S0360-3016(02)02958-9CrossRefPubMed
3.
Kong FM, Ten Haken RK, Schipper MJ, Sullivan MA, Chen M, Lopez C, Kalemkerian GP, Hayman JA: High-dose radiation improved local tumor control and overall survival in patients with inoperable/unresectable non-small-cell lung cancer (long-term results of a radiation dose escalation study). Int J Radiat Oncol Biol Phys 2005,63(2):324-33. 10.1016/j.ijrobp.2005.02.010CrossRefPubMed
4.
Shimizu S, Shirato H, Ogura S, Akita-Dosaka H, Kitamura K, Nishioka T, Kagei K, Nishimura M, Miyasaka K: Detection of lung tumor movement in real-time tumor-tracking radiotherapy. Int J Radiat Oncol Biol Phys 2001,51(2):304-310. 10.1016/S0360-3016(01)01641-8CrossRefPubMed
5.
Ford EC, Mageras GS, Yorke E, Rosenzweig KE, Wagman R, Ling CC: Evaluation of respiratory movement during gated radiotherapy using film and electronic portal imaging. Int J Radiat Oncol Biol Phys 2002,52(2):522-531. 10.1016/S0360-3016(01)02681-5CrossRefPubMed
6.
Shirato H, Shimizu S, Kunieda T, Kitamura K, van Herk M, Kagei K, Nishioka T, Hashimoto S, Fujita K, Aoyama H, Tsuchiya K, Kudo K, Miyasaka K: Physical aspects of a real-time tumor-tracking system for gated radiotherapy. Int J Radiat Oncol Biol Phys 2000,48(4):1187-1195. 10.1016/S0360-3016(00)00748-3CrossRefPubMed
7.
Wolthaus JW, Sonke JJ, van Herk M, Damen EM: Reconstruction of a time-averaged midposition CT scan for radiotherapy planning of lung cancer patients using deformable registration. Med Phys 2008,35(9):3998-4011. 10.1118/1.2966347CrossRefPubMed
8.
Keall PJ, Starkschall G, Shukla H, Forster KM, Ortiz V, Stevens CW, Vedam SS, George R, Guerrero T, Mohan R: Acquiring 4D thoracic CT scans using a multislice helical method. Phys Med Biol 2004, 49: 2053-2067. 10.1088/0031-9155/49/10/015CrossRefPubMed
9.
Starkschall G, Britton K, McAleer MF, Jeter MD, Kaus MR, Bzdusek K, Mohan R, Cox JD: Potential dosimetric benefits of four-dimensional radiation treatment planning. Int J Radiat Oncol Biol Phys 2009,73(5):1560-5. 10.1016/j.ijrobp.2008.12.024CrossRefPubMed
10.
Keall P: 4-dimensional computed tomography imaging and treatment planning. Seminars in Radiation Oncology 2004,14(1):81-90. 10.1053/j.semradonc.2003.10.006CrossRefPubMed
11.
Wolthaus JW, Sonke JJ, van Herk M, Belderbos JS, Rossi MM, Lebesque JV, Damen EM: Comparison of different strategies to use four-dimensional computed tomography in treatment planning for lung cancer patients. Int J Radiat Oncol Biol Phys 2008,70(4):1229-38. 10.1016/j.ijrobp.2007.11.042CrossRefPubMed
12.
Barnes EA, Murray BR, Robinson DM, Underwood LJ, Hanson J, Roa WH: Dosimetric evaluation of lung tumor immobilization using breath hold at deep inspiration. Int J Radiat Oncol Biol Phys 2001,50(4):1091-1098. 10.1016/S0360-3016(01)01592-9CrossRefPubMed
13.
Hanley J, Debois MM, Mah D, Mageras GS, Raben A, Rosenzweig K, Mychalczak B, Schwartz LH, Gloeggler PJ, Lutz W, Ling CC, Leibel SA, Fuks Z, Kutcher GJ: Deep inspiration breath-hold technique for lung tumors (the potential value of target immobilization and reduced lung density in dose escalation). Int J Radiat Oncol Biol Phys 1999,45(3):603-11. 10.1016/S0360-3016(99)00154-6CrossRefPubMed
14.
Balter JM, Lam KL, McGinn CJ, Lawrence TS, Ten Haken RK: Improvement of CT-based treatment-planning models of abdominal targets using static exhale imaging. Int J Radiat Oncol Biol Phys 1998,41(4):939-43. 10.1016/S0360-3016(98)00130-8CrossRefPubMed
15.
Wallis JW, Miller TR, Lerner CA, Kleerup EC: Three-dimensional display in nuclear medicine. IEEE Trans Med Imaging 1989,8(4):297-303. 10.1109/42.41482CrossRefPubMed
16.
Underberg RW, Lagerwaard FJ, Slotman BJ, Cuijpers JP, Senan S: Use of maximum intensity projections (MIP) for target volume generation in 4DCT scans for lung cancer. Int J Radiat Oncol Biol Phys 2005,63(1):253-60. 10.1016/j.ijrobp.2005.05.045CrossRefPubMed
17.
(Critical structures in): RTOG 0617, a randomized phase III comparison of standard- dose (60Gy) versus high-dose (74Gy) conformal radiotherapy with concurrent and consolidation carboplatin/paclitaxel+/- cetuximab in patients with stage IIIA/IIIB non-small cell lung cancer.
18.
Seppenwoolde Y, Shirato H, Kitamura K, Shimizu S, van Herk M, Lebesque JV, Miyasaka K: Precise and real-time measurement of 3D tumor motion in lung due to breathing and heartbeat, measured during radiotherapy. Int J Radiat Oncol Biol Phys 2002,53(4):822-834. 10.1016/S0360-3016(02)02803-1CrossRefPubMed
19.
Giraud P, De Rycke Y, Dubray B, Helfre S, Voican D, Guo L, Rosenwald JC, Keraudy K, Housset M, Touboul E, Cosset JM: Conformal radiotherapy (CRT) planning for lung cancer (analysis of intrathoracic organ motion during extreme phases of breathing). Int J Radiat Oncol Biol Phys 2001,51(4):1081-1092. 10.1016/S0360-3016(01)01766-7CrossRefPubMed
20.
Forster KM, Stevens CW, Kitamura K, Chang JY, Cox JD, Guerrero TM, Jeter M, Liao Z, Starkschall G, Komaki R: Changes of Tumor Motion Patterns During a Course of Radiation Therapy for Lung Cancer [abstract]. Int J Radiat Oncol Biol Phys 2003,57(Suppl 2):S234.CrossRef
21.
Hernando ML, Marks LB, Bentel GC, Zhou SM, Hollis D, Das SK, Fan M, Munley MT, Shafman TD, Anscher MS, Lind PA: Radiation-induced pulmonary toxicity (a dose-volume histogram analysis in 201 patients with lung cancer). Int J Radiat Oncol Biol Phys 2001,51(3):650-9. 10.1016/S0360-3016(01)01685-6CrossRefPubMed
22.
Graham MV, Purdy JA, Emami B, Harms W, Bosch W, Lockett MA, Perez CA: Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys 1999,45(2):323-9. 10.1016/S0360-3016(99)00183-2CrossRefPubMed
23.
Kwa SL, Lebesque JV, Theuws JC, Marks LB, Munley MT, Bentel G, Oetzel D, Spahn U, Graham MV, Drzymala RE, Purdy JA, Lichter AS, Martel MK, Ten Haken RK: Radiation pneumonitis as a function of mean lung dose (an analysis of pooled data of 540 patients). Int J Radiat Oncol Biol Phys 1998,42(1):1-9.CrossRefPubMed
24.
Starkschall G, Forster KM, Kitamura K, Cardenas A, Tucker SL, Stevens CW: Correlation of gross tumor volume excursion with potential benefits of respiratory gating. Int J Radiat Oncol Biol Phys 2004,60(4):1291-7. 10.1016/j.ijrobp.2004.07.707CrossRefPubMed
25.
Louie AV, Rodrigues G, Olsthoorn J, Palma D, Yu E, Yaremko B, Ahmad B, Aivas I, Gaede S: Inter-observer and intra-observer reliability for lung cancer target volume delineation in the 4D-CT era. Radiother Oncol 2010,95(2):166-71. 10.1016/j.radonc.2009.12.028CrossRefPubMed
Metadata
Title
Breathing adapted radiotherapy: a 4D gating software for lung cancer
Authors
Nicolas Peguret
Jacqueline Vock
Vincent Vinh-Hung
Pascal Fenoglietto
David Azria
Habib Zaidi
Michael Wissmeyer
Osman Ratib
Raymond Miralbell
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2011
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-6-78

Other articles of this Issue 1/2011

Radiation Oncology 1/2011 Go to the issue

Research

Impact of tumor volume and systemic therapy on outcome in patients undergoing IMRT for large volume head neck cancer

Research

Biological in-vivo measurement of dose distribution in patients' lymphocytes by gamma-H2AX immunofluorescence staining: 3D conformal- vs. step-and-shoot IMRT of the prostate gland

Research

Liposomal doxorubicin improves radiotherapy response in hypoxic prostate cancer xenografts

Research

Clinical practice of image-guided spine radiosurgery - results from an international research consortium

Research

Quantitative assessment of inter-observer variability in target volume delineation on stereotactic radiotherapy treatment for pituitary adenoma and meningioma near optic tract

Research

A specific inhibitor of protein kinase CK2 delays gamma-H2Ax foci removal and reduces clonogenic survival of irradiated mammalian cells