Effectiveness of the Respiratory Gating System for Stereotectic Radiosurgery of Lung Cancer

Lung Cancer의 Stereotactic Radiosurgery시 Respiratory Gating system의 유용성에 대한 연구

Introduction : For stereotactic radiosurgery (SRS) of a tumor in the region whose movement due to respiration is significant, like Lung lower lobe, the gated therapy, which delivers radiation dose to the selected respiratory phases when tumor motion is small, was peformed using the Respiratory gating system and its clinical effectiveness was evaluated. Methode and Materials : For two SRS patients with a tumor in Lung lower lobe, a marker block (infrared reflector) was attached on the abdomen. While patient' respiratory cycle was monitored with Real-time Position Management (RPM, Varian, USA), 4D CT was performed (10 phases per a cycle). Phases in which tumor motion did not change rapidly were decided as treatment phases. The treatment volume was contoured on the CT images for selected treatment phases using maximum intensity projection (MIP) method. In order to verify setup reproducibility and positional variation, 4D CT was repeated. Result : Gross tumor volume (GTV) showed maximum movement in superior-inferior direction. For patient $\#$1, motion of GTV was reduced to 2.6 mm in treatment phases ($30\%\~60\%$), while that was 9.4 mm in full phases ($0\%\~90\%$) and for patient $\#$2, it was reduced to 2.3 mm in treatment phases ($30\%\~70\%$), while it was 11.7 mm in full phases ($0\%\~90\%$). When comparing two sets of CT images, setup errors in all the directions were within 3 mm. Conclusion : Since tumor motion was reduced less than 5 mm, the Respiratory gating system for SRS of Lung lower lobe is useful.

Lung cancer 환자 중 호흡에 의한 종양의 움직임이 큰 lung lower lobe에서 stetreotactic radiosurgery(SRS)시 호흡 주기 중 종양의 움직임이 적은 호흡 주기에서만 방사선을 조사하기 위해 respiratory gating system을 사용함으로써 그 유용성에 대하여 알아보고자 한다. lung lower lobe의 SRS 환자 2명을 대강으로 하였으며, 환자의 복부에 maker block(sensor)을 부착하고 tracking camera와 real time position management(RPM)를 이용하여 호흡 주기를 측정하면서 1회 호흡주기에서 10 phases의 4D-CT를 촬영 하였다. 종양의 위치 변화가 급격하지 않은 percent($\%$)의 phases를 치료 phases로 결정하였고, 치료 phases의 CT image를 maximum intensity projection(MIP) 기법으로 재구성 후 volume contouring을 하였다. set up 의 재현성 및 GTV의 위치 변화를 확인하기 위해 치료 전과 치료 중 2회의 4D-CT 촬영을 하였다. GTV의 움직임이 가장 큰 Y(longitudinal)축에서 A환자 full($0\%\~90\%$) phases의 9.4mm가 치료 ($30\%\~60\%$) phases 에서는 2.6mm로, B환자 full($0\%\~90\%$) phases의 11.7mm가 치료($30\%\~70\%$) phases 에서는 2.3mm로 줄었다. 2회의 4D-CT 비교 결과 Set up의 X, Y, Z축 오차는 모두 3mm 이내였다. 호흡에 의한 종양의 움직임이 큰 lung lower lobe에서 SRS 시행 시 respiratory gating system의 사용은 종양의 움직임을 5mm 이내로 감소시킬 수 있어 유용하였다.