Pancreatic SABR using peritumoral fiducials, triggered imaging and breath-hold
Background: We aim to present our linear accelerator-based workflow for pancreatic stereotactic ablative radiotherapy (SABR) in order to address the following issues: intrafractional organ motion management, Cone Beam CT (CBCT) image quality, residual errors with dosimetric consequences, treatment t...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-12-01
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| Series: | Pathology and Oncology Research |
| Subjects: | |
| Online Access: | https://www.por-journal.com/articles/10.3389/pore.2023.1611456/full |
| _version_ | 1797222336877821952 |
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| author | Katalin Kisivan Andrea Farkas Peter Kovacs Csaba Glavak Gabor Lukacs Karoly Mahr Zsolt Szabo Melinda Petone Csima Melinda Petone Csima Akos Gulyban Akos Gulyban Zoltan Toth Zoltan Toth Zsolt Kaposztas Ferenc Lakosi Ferenc Lakosi |
| author_facet | Katalin Kisivan Andrea Farkas Peter Kovacs Csaba Glavak Gabor Lukacs Karoly Mahr Zsolt Szabo Melinda Petone Csima Melinda Petone Csima Akos Gulyban Akos Gulyban Zoltan Toth Zoltan Toth Zsolt Kaposztas Ferenc Lakosi Ferenc Lakosi |
| author_sort | Katalin Kisivan |
| collection | DOAJ |
| description | Background: We aim to present our linear accelerator-based workflow for pancreatic stereotactic ablative radiotherapy (SABR) in order to address the following issues: intrafractional organ motion management, Cone Beam CT (CBCT) image quality, residual errors with dosimetric consequences, treatment time, and clinical results.Methods: Between 2016 and 2021, 14 patients with locally advanced pancreatic cancer were treated with induction chemotherapy and SABR using volumetric modulated arc therapy (VMAT). Internal target volume (ITV) concept (5), phase-gated (4), or breath hold (5) techniques were used. Treatment was verified by CBCT before and after irradiation, while tumor motion was monitored and controlled by kV triggered imaging and beam hold using peritumoral surgical clips. Beam interruptions and treatment time were recorded. The CBCT image quality was scored and supplemented by an agreement analysis (Krippendorff’s-α) of breath-hold CBCT images to determine the position of OARs relative to the planning risk volumes (PRV). Residual errors and their dosimetry impact were also calculated. Progression free (PFS) and overall survival (OS) were assessed by the Kaplan-Meier analysis with acute and late toxicity reporting (CTCAEv4).Results: On average, beams were interrupted once (range: 0–3) per treatment session on triggered imaging. The total median treatment time was 16.7 ± 10.8 min, significantly less for breath-hold vs. phase-gated sessions (18.8 ± 6.2 vs. 26.5 ± 13.4, p < 0.001). The best image quality was achieved by breath hold CBCT. The Krippendorff’s-α test showed a strong agreement among five radiation therapists (mean K-α value: 0.8 (97.5%). The mean residual errors were <0.2 cm in each direction resulting in an average difference of <2% in dosimetry for OAR and target volume. Two patients received offline adaptation. The median OS/PFS after induction chemotherapy and SABR was 20/12 months and 15/8 months. No Gr. ≥2 acute/late RT-related toxicity was noted.Conclusion: Linear accelerator based pancreatic SABR with the combination of CBCT and triggered imaging + beam hold is feasible. Peritumoral fiducials improve utility while breath-hold CBCT provides the best image quality at a reasonable treatment time with offline adaptation possibilities. In well-selected cases, it can be an effective alternative in clinics where CBCT/MRI-guided online adaptive workflow is not available. |
| first_indexed | 2024-04-24T13:19:43Z |
| format | Article |
| id | doaj.art-b774ae876efc4aa7972349150aac76c7 |
| institution | Directory Open Access Journal |
| issn | 1532-2807 |
| language | English |
| last_indexed | 2024-04-24T13:19:43Z |
| publishDate | 2023-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Pathology and Oncology Research |
| spelling | doaj.art-b774ae876efc4aa7972349150aac76c72024-04-04T16:24:32ZengFrontiers Media S.A.Pathology and Oncology Research1532-28072023-12-012910.3389/pore.2023.16114561611456Pancreatic SABR using peritumoral fiducials, triggered imaging and breath-holdKatalin Kisivan0Andrea Farkas1Peter Kovacs2Csaba Glavak3Gabor Lukacs4Karoly Mahr5Zsolt Szabo6Melinda Petone Csima7Melinda Petone Csima8Akos Gulyban9Akos Gulyban10Zoltan Toth11Zoltan Toth12Zsolt Kaposztas13Ferenc Lakosi14Ferenc Lakosi15Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, HungaryDepartment of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, HungaryDepartment of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, HungaryDepartment of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, HungaryDepartment of Medical Oncology, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, HungaryDepartment of Medical Oncology, Zala County Szent Raphael Hospital, Zalaegerszeg, HungaryDepartment of Medical Oncology, Zala County Szent Raphael Hospital, Zalaegerszeg, HungaryInstitute of Education, Hungarian University of Agricultural and Life Sciences, Gödöllő, HungaryFaculty of Health Sciences, University of Pecs, Pecs, HungaryDepartment of Medical Physics, Institut Jules Bordet, Brussels, BelgiumRadiophysics and MRI Physics Laboratory, Université Libre De Bruxelles (ULB), Brussels, BelgiumMedicopus Nonprofit Ltd., Somogy County Kaposi Mór Teaching Hospital, Kaposvár, HungaryPET Center, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary0Department of Surgery, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, HungaryDepartment of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, HungaryFaculty of Health Sciences, University of Pecs, Pecs, HungaryBackground: We aim to present our linear accelerator-based workflow for pancreatic stereotactic ablative radiotherapy (SABR) in order to address the following issues: intrafractional organ motion management, Cone Beam CT (CBCT) image quality, residual errors with dosimetric consequences, treatment time, and clinical results.Methods: Between 2016 and 2021, 14 patients with locally advanced pancreatic cancer were treated with induction chemotherapy and SABR using volumetric modulated arc therapy (VMAT). Internal target volume (ITV) concept (5), phase-gated (4), or breath hold (5) techniques were used. Treatment was verified by CBCT before and after irradiation, while tumor motion was monitored and controlled by kV triggered imaging and beam hold using peritumoral surgical clips. Beam interruptions and treatment time were recorded. The CBCT image quality was scored and supplemented by an agreement analysis (Krippendorff’s-α) of breath-hold CBCT images to determine the position of OARs relative to the planning risk volumes (PRV). Residual errors and their dosimetry impact were also calculated. Progression free (PFS) and overall survival (OS) were assessed by the Kaplan-Meier analysis with acute and late toxicity reporting (CTCAEv4).Results: On average, beams were interrupted once (range: 0–3) per treatment session on triggered imaging. The total median treatment time was 16.7 ± 10.8 min, significantly less for breath-hold vs. phase-gated sessions (18.8 ± 6.2 vs. 26.5 ± 13.4, p < 0.001). The best image quality was achieved by breath hold CBCT. The Krippendorff’s-α test showed a strong agreement among five radiation therapists (mean K-α value: 0.8 (97.5%). The mean residual errors were <0.2 cm in each direction resulting in an average difference of <2% in dosimetry for OAR and target volume. Two patients received offline adaptation. The median OS/PFS after induction chemotherapy and SABR was 20/12 months and 15/8 months. No Gr. ≥2 acute/late RT-related toxicity was noted.Conclusion: Linear accelerator based pancreatic SABR with the combination of CBCT and triggered imaging + beam hold is feasible. Peritumoral fiducials improve utility while breath-hold CBCT provides the best image quality at a reasonable treatment time with offline adaptation possibilities. In well-selected cases, it can be an effective alternative in clinics where CBCT/MRI-guided online adaptive workflow is not available.https://www.por-journal.com/articles/10.3389/pore.2023.1611456/fullmotion controlpancreatic cancertriggered imagingstereotactic ablative radiotherapydeep inspiration breath hold |
| spellingShingle | Katalin Kisivan Andrea Farkas Peter Kovacs Csaba Glavak Gabor Lukacs Karoly Mahr Zsolt Szabo Melinda Petone Csima Melinda Petone Csima Akos Gulyban Akos Gulyban Zoltan Toth Zoltan Toth Zsolt Kaposztas Ferenc Lakosi Ferenc Lakosi Pancreatic SABR using peritumoral fiducials, triggered imaging and breath-hold Pathology and Oncology Research motion control pancreatic cancer triggered imaging stereotactic ablative radiotherapy deep inspiration breath hold |
| title | Pancreatic SABR using peritumoral fiducials, triggered imaging and breath-hold |
| title_full | Pancreatic SABR using peritumoral fiducials, triggered imaging and breath-hold |
| title_fullStr | Pancreatic SABR using peritumoral fiducials, triggered imaging and breath-hold |
| title_full_unstemmed | Pancreatic SABR using peritumoral fiducials, triggered imaging and breath-hold |
| title_short | Pancreatic SABR using peritumoral fiducials, triggered imaging and breath-hold |
| title_sort | pancreatic sabr using peritumoral fiducials triggered imaging and breath hold |
| topic | motion control pancreatic cancer triggered imaging stereotactic ablative radiotherapy deep inspiration breath hold |
| url | https://www.por-journal.com/articles/10.3389/pore.2023.1611456/full |
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