Liver stereotactic body radiation therapy without fiducial or retained ethiodized oil guidance warrants greater than 5 mm planning target volumes
Abstract Introduction For liver stereotactic body radiation therapy (SBRT), the placement of fiducial markers or retained ethiodized oil by transarterial chemoembolisation (TACE) provides a landmark for consistent target localisation. TACE and fiducial markers are invasive procedures that harbour ad...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-03-01
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| Series: | Journal of Medical Radiation Sciences |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jmrs.726 |
| _version_ | 1797268911832432640 |
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| author | Alec Breazeale Ramtin Rahmani Kyle Gallagher Nima Nabavizadeh |
| author_facet | Alec Breazeale Ramtin Rahmani Kyle Gallagher Nima Nabavizadeh |
| author_sort | Alec Breazeale |
| collection | DOAJ |
| description | Abstract Introduction For liver stereotactic body radiation therapy (SBRT), the placement of fiducial markers or retained ethiodized oil by transarterial chemoembolisation (TACE) provides a landmark for consistent target localisation. TACE and fiducial markers are invasive procedures that harbour additional risks. We hypothesise that liver SBRT can be accurately delivered without the use of these invasive surrogate markers. Methods We retrospectively identified 50 consecutive patients who underwent liver SBRT with respiratory motion management to a single lesion which exhibited retained ethiodized oil per prior TACE delivery. For each SBRT fraction, two manual rigid image registrations were performed by the treating physician. One using the liver contour as a surrogate for the target and second aligning only to the radio‐opaque retained ethiodized oil of the treated lesion. The magnitude of the displacement vector between the two registration methods was used to assess the accuracy of target localisation if ethiodized oil was not present. Results For the 50 patients, a total of 244 analysable cone‐beam CTs (CBCTs) were included (six CBCTs excluded due to poor ethiodized oil visualisation). Respiratory motion management techniques consisted of active breathing control for 13 and abdominal compression for 37 patients. Forty‐two patients had peripheral lesions and eight had central lesions (<2 cm from left and right portal veins). The average target localisation offset between the two registration methods (i.e. liver contour vs. retained ethiodized oil alignment) for patients with a single peripheral or central liver lesion was 5.8 and 5.3 mm, respectively. Conclusions Across all patients, the average change in target position exceeded 5 mm for image registration methods based on the liver contour alone versus the retained ethiodized oil region. This suggests that margins greater than 5 mm may be required for respiratory motion‐managed liver SBRT treatments in patients who do not undergo prior TACE or fiducial placement. |
| first_indexed | 2024-04-25T01:40:00Z |
| format | Article |
| id | doaj.art-6f9a815e57c74a6f8e81aff4be055824 |
| institution | Directory Open Access Journal |
| issn | 2051-3895 2051-3909 |
| language | English |
| last_indexed | 2024-04-25T01:40:00Z |
| publishDate | 2024-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Medical Radiation Sciences |
| spelling | doaj.art-6f9a815e57c74a6f8e81aff4be0558242024-03-08T05:32:44ZengWileyJournal of Medical Radiation Sciences2051-38952051-39092024-03-0171111011310.1002/jmrs.726Liver stereotactic body radiation therapy without fiducial or retained ethiodized oil guidance warrants greater than 5 mm planning target volumesAlec Breazeale0Ramtin Rahmani1Kyle Gallagher2Nima Nabavizadeh3Department of Radiation Medicine Oregon Health & Science University Portland Oregon USADepartment of Radiation Medicine Oregon Health & Science University Portland Oregon USADepartment of Radiation Oncology University of Nebraska Medical Center Omaha Nebraska USADepartment of Radiation Medicine Oregon Health & Science University Portland Oregon USAAbstract Introduction For liver stereotactic body radiation therapy (SBRT), the placement of fiducial markers or retained ethiodized oil by transarterial chemoembolisation (TACE) provides a landmark for consistent target localisation. TACE and fiducial markers are invasive procedures that harbour additional risks. We hypothesise that liver SBRT can be accurately delivered without the use of these invasive surrogate markers. Methods We retrospectively identified 50 consecutive patients who underwent liver SBRT with respiratory motion management to a single lesion which exhibited retained ethiodized oil per prior TACE delivery. For each SBRT fraction, two manual rigid image registrations were performed by the treating physician. One using the liver contour as a surrogate for the target and second aligning only to the radio‐opaque retained ethiodized oil of the treated lesion. The magnitude of the displacement vector between the two registration methods was used to assess the accuracy of target localisation if ethiodized oil was not present. Results For the 50 patients, a total of 244 analysable cone‐beam CTs (CBCTs) were included (six CBCTs excluded due to poor ethiodized oil visualisation). Respiratory motion management techniques consisted of active breathing control for 13 and abdominal compression for 37 patients. Forty‐two patients had peripheral lesions and eight had central lesions (<2 cm from left and right portal veins). The average target localisation offset between the two registration methods (i.e. liver contour vs. retained ethiodized oil alignment) for patients with a single peripheral or central liver lesion was 5.8 and 5.3 mm, respectively. Conclusions Across all patients, the average change in target position exceeded 5 mm for image registration methods based on the liver contour alone versus the retained ethiodized oil region. This suggests that margins greater than 5 mm may be required for respiratory motion‐managed liver SBRT treatments in patients who do not undergo prior TACE or fiducial placement.https://doi.org/10.1002/jmrs.726Clinical applicationgastro intestinaloncologyradiation oncologystereotactic radiotherapy |
| spellingShingle | Alec Breazeale Ramtin Rahmani Kyle Gallagher Nima Nabavizadeh Liver stereotactic body radiation therapy without fiducial or retained ethiodized oil guidance warrants greater than 5 mm planning target volumes Journal of Medical Radiation Sciences Clinical application gastro intestinal oncology radiation oncology stereotactic radiotherapy |
| title | Liver stereotactic body radiation therapy without fiducial or retained ethiodized oil guidance warrants greater than 5 mm planning target volumes |
| title_full | Liver stereotactic body radiation therapy without fiducial or retained ethiodized oil guidance warrants greater than 5 mm planning target volumes |
| title_fullStr | Liver stereotactic body radiation therapy without fiducial or retained ethiodized oil guidance warrants greater than 5 mm planning target volumes |
| title_full_unstemmed | Liver stereotactic body radiation therapy without fiducial or retained ethiodized oil guidance warrants greater than 5 mm planning target volumes |
| title_short | Liver stereotactic body radiation therapy without fiducial or retained ethiodized oil guidance warrants greater than 5 mm planning target volumes |
| title_sort | liver stereotactic body radiation therapy without fiducial or retained ethiodized oil guidance warrants greater than 5 mm planning target volumes |
| topic | Clinical application gastro intestinal oncology radiation oncology stereotactic radiotherapy |
| url | https://doi.org/10.1002/jmrs.726 |
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