The Journal of Korean Society for Radiation Therapy (대한방사선치료학회지)

Korean Society for Radiation Therapy (대한방사선치료학회)
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Analysis of inter-fraction and intra-fraction errors during volumetric modulated arc therapy in Pancreas Ca

호흡 동조 췌장 암 용적 세기조절 회전 치료 시 Inter-fraction Intra-fraction 분석

  • Jo, Young Pil (Department of Radiation Oncology, Asan Medical Center) ;
  • Seo, Dong Rin (Department of Radiation Oncology, Asan Medical Center) ;
  • Hong, Taek Kyun (Department of Radiation Oncology, Asan Medical Center) ;
  • Kang, Tae Yeong (Department of Radiation Oncology, Asan Medical Center) ;
  • Beck, Geum Mun (Department of Radiation Oncology, Asan Medical Center) ;
  • Hong, Dong Ki (Department of Radiation Oncology, Asan Medical Center) ;
  • Yun, In Ha (Department of Radiation Oncology, Asan Medical Center) ;
  • Kim, Jin San (Department of Radiation Oncology, Asan Medical Center)
  • 조영필 (서울아산병원 방사선종양학과) ;
  • 서동린 (서울아산병원 방사선종양학과) ;
  • 홍택균 (서울아산병원 방사선종양학과) ;
  • 강태영 (서울아산병원 방사선종양학과) ;
  • 백금문 (서울아산병원 방사선종양학과) ;
  • 홍동기 (서울아산병원 방사선종양학과) ;
  • 윤인하 (서울아산병원 방사선종양학과) ;
  • 김진산 (서울아산병원 방사선종양학과)
  • Received : 2014.09.30
  • Accepted : 2014.12.02
  • Published : 2014.12.30
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Abstract

Purpose : To assess target motion during radiotherapy by quantifying daily setup errors and inter-fractional and intra-fractional movements of pancreatic fiducials. Materials and Methods : Eleven patients were treated via stereotactic body radiotherapy (SBRT) with volumetric modulated arc therapy. Bony setup errors were calculated using cone beam computed tomography (CBCT). Inter-fractional and intrafractional fiducial (seed) motion was determined via cone beam computed tomography (CBCT) projections and orthogonal fluoroscopy. Results : Using an off-line correction protocol, setup errors were 0.0 (-1.7-4.0), 0.3 (-0.5-3.0), and 0.0 (-4.1-6.6) mm for the left-right, anterior-posterior, and superior-inferior directions respectively. Random inter-fractional setup errors in the mean fiducial positions were -0.1, -1.1, and -2.3 mm respectively. Intra-fractional fiducial margins were 9.9, 7.8, and 12.5 mm, respectively. Conclusion : Online inter-fractional and intra-fractional corrections based on daily kV images and CBCT expedites SBRT of pancreatic cancer. Importantly, inter-fractional and intra-fractional motion needs to be measured regularly during treatment of pancreatic cancer to account for variations in patient respiration.

목 적 : 췌장 환자 방사선 치료 중 기점(Fiducial) 대상 내부 및 외부 종양 움직임의 오차를 정량화 하고자 한다. 또한 cone beam computed tomography (CBCT) 를 기반으로 호흡 시 췌장의 움직임 분석하고자 한다. 대상 및 방법 : 용적 세기변조 회전조사 (V-MAT)를 적용, 정위적 방사선 치료를 국소 진행성 췌장암 환자 11명을 대상으로 하였다. CBCT 및 직교 투시이미지를 적용하여 기점(Fiducial Marker)의 Inter, intra-fraction 움직임 변화를 치료 전, 치료 진행 시 분석하였다. 결 과 : 치료 후 프로토콜을 오프라인 교정 프로토콜을 사용하여, CBCT 와 직교투시 간의 평균 오차(범위)는 0.0(-1.7~4.0), 0.3(-0.5~3.0) and 0.0(-4.1~6.6)mm 측방 (LR), 세로 (AP) 및 종 방향 (SI) 이였다. 무작위 Inter-fraction Setup 오차 결과는 -0.1, -2.3 and -1.1 mm: 95% Fiducial포함 마진은 각 9.9, 7.8, 12.5mm로 수식되었다. 결 론 : 위 분석으로 뼈 일치 정렬 후 잔류 불확실성이 있으며, SI 방향에 큰 임의의 움직임은 적합한 여백이 필요하다. 주변 내부 장기를 보호, 내부 장기 문제점을 최소화, 호흡편차를 고려, 치료 시 정기적으로 측정하여야 한다.

Keywords

References

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