Clinical and Dosimetric Impact of 2D kV Motion Monitoring and Intervention in Liver Stereotactic Body Radiation Therapy
Purpose: Positional errors resulting from motion are a principal challenge across all disease sites in radiation therapy. This is particularly pertinent when treating lesions in the liver with stereotactic body radiation therapy (SBRT). To achieve dose escalation and margin reduction for liver SBRT,...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109423002373 |
| _version_ | 1827378757874221056 |
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| author | Andrew P. Santoso, PhD Yevgeniy Vinogradskiy, PhD Tyler P. Robin, MD, PhD Karyn A. Goodman, MD Tracey E. Schefter, MD Moyed Miften, PhD Bernard L. Jones, PhD |
| author_facet | Andrew P. Santoso, PhD Yevgeniy Vinogradskiy, PhD Tyler P. Robin, MD, PhD Karyn A. Goodman, MD Tracey E. Schefter, MD Moyed Miften, PhD Bernard L. Jones, PhD |
| author_sort | Andrew P. Santoso, PhD |
| collection | DOAJ |
| description | Purpose: Positional errors resulting from motion are a principal challenge across all disease sites in radiation therapy. This is particularly pertinent when treating lesions in the liver with stereotactic body radiation therapy (SBRT). To achieve dose escalation and margin reduction for liver SBRT, kV real-time imaging interventions may serve as a potential solution. In this study, we report results of a retrospective cohort of liver patients treated using real-time 2D kV-image guidance SBRT with emphasis on the impact of (1) clinical workflow, (2) treatment accuracy, and (3) tumor dose. Methods and Materials: Data from 33 patients treated with 41 courses of liver SBRT were analyzed. During treatment, planar kV images orthogonal to the treatment beam were acquired to determine treatment interventions, namely treatment pauses (ie, adequacy of gating thresholds) or treatment shifts. Patients were shifted if internal markers were >3 mm, corresponding to the PTV margin used, from the expected reference condition. The frequency, duration, and nature of treatment interventions (ie, pause vs shift) were recorded, and the dosimetric impact associated with treatment shifts was estimated using a machine learning dosimetric model. Results: Of all fractions delivered, 39% required intervention, which took on average 1.9 ± 1.6 minutes and occurred more frequently in treatments lasting longer than 7 minutes. The median realignment shift was 5.7 mm in size, and the effect of these shifts on minimum tumor dose in simulated clinical scenarios ranged from 0% to 50% of prescription dose per fraction. Conclusion: Real-time kV-based imaging interventions for liver SBRT minimally affect clinical workflow and dosimetrically benefit patients. This potential solution for addressing positional errors from motion addresses concerns about target accuracy and may enable safe dose escalation and margin reduction in the context of liver SBRT. |
| first_indexed | 2024-03-08T13:02:28Z |
| format | Article |
| id | doaj.art-b055bc7aaa2e4893816a3955582b1819 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-03-08T13:02:28Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-b055bc7aaa2e4893816a3955582b18192024-01-19T05:00:41ZengElsevierAdvances in Radiation Oncology2452-10942024-03-0193101409Clinical and Dosimetric Impact of 2D kV Motion Monitoring and Intervention in Liver Stereotactic Body Radiation TherapyAndrew P. Santoso, PhD0Yevgeniy Vinogradskiy, PhD1Tyler P. Robin, MD, PhD2Karyn A. Goodman, MD3Tracey E. Schefter, MD4Moyed Miften, PhD5Bernard L. Jones, PhD6Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado; Corresponding author: Andrew Santoso, PhDDepartment of Radiation Oncology, Thomas Jefferson University, Philadelphia, PennsylvaniaDepartment of Radiation Oncology, University of Colorado School of Medicine, Aurora, ColoradoDepartment of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New YorkDepartment of Radiation Oncology, University of Colorado School of Medicine, Aurora, ColoradoDepartment of Radiation Oncology, University of Colorado School of Medicine, Aurora, ColoradoDepartment of Radiation Oncology, University of Colorado School of Medicine, Aurora, ColoradoPurpose: Positional errors resulting from motion are a principal challenge across all disease sites in radiation therapy. This is particularly pertinent when treating lesions in the liver with stereotactic body radiation therapy (SBRT). To achieve dose escalation and margin reduction for liver SBRT, kV real-time imaging interventions may serve as a potential solution. In this study, we report results of a retrospective cohort of liver patients treated using real-time 2D kV-image guidance SBRT with emphasis on the impact of (1) clinical workflow, (2) treatment accuracy, and (3) tumor dose. Methods and Materials: Data from 33 patients treated with 41 courses of liver SBRT were analyzed. During treatment, planar kV images orthogonal to the treatment beam were acquired to determine treatment interventions, namely treatment pauses (ie, adequacy of gating thresholds) or treatment shifts. Patients were shifted if internal markers were >3 mm, corresponding to the PTV margin used, from the expected reference condition. The frequency, duration, and nature of treatment interventions (ie, pause vs shift) were recorded, and the dosimetric impact associated with treatment shifts was estimated using a machine learning dosimetric model. Results: Of all fractions delivered, 39% required intervention, which took on average 1.9 ± 1.6 minutes and occurred more frequently in treatments lasting longer than 7 minutes. The median realignment shift was 5.7 mm in size, and the effect of these shifts on minimum tumor dose in simulated clinical scenarios ranged from 0% to 50% of prescription dose per fraction. Conclusion: Real-time kV-based imaging interventions for liver SBRT minimally affect clinical workflow and dosimetrically benefit patients. This potential solution for addressing positional errors from motion addresses concerns about target accuracy and may enable safe dose escalation and margin reduction in the context of liver SBRT.http://www.sciencedirect.com/science/article/pii/S2452109423002373 |
| spellingShingle | Andrew P. Santoso, PhD Yevgeniy Vinogradskiy, PhD Tyler P. Robin, MD, PhD Karyn A. Goodman, MD Tracey E. Schefter, MD Moyed Miften, PhD Bernard L. Jones, PhD Clinical and Dosimetric Impact of 2D kV Motion Monitoring and Intervention in Liver Stereotactic Body Radiation Therapy Advances in Radiation Oncology |
| title | Clinical and Dosimetric Impact of 2D kV Motion Monitoring and Intervention in Liver Stereotactic Body Radiation Therapy |
| title_full | Clinical and Dosimetric Impact of 2D kV Motion Monitoring and Intervention in Liver Stereotactic Body Radiation Therapy |
| title_fullStr | Clinical and Dosimetric Impact of 2D kV Motion Monitoring and Intervention in Liver Stereotactic Body Radiation Therapy |
| title_full_unstemmed | Clinical and Dosimetric Impact of 2D kV Motion Monitoring and Intervention in Liver Stereotactic Body Radiation Therapy |
| title_short | Clinical and Dosimetric Impact of 2D kV Motion Monitoring and Intervention in Liver Stereotactic Body Radiation Therapy |
| title_sort | clinical and dosimetric impact of 2d kv motion monitoring and intervention in liver stereotactic body radiation therapy |
| url | http://www.sciencedirect.com/science/article/pii/S2452109423002373 |
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