Optimising PTV margins in oesophageal cancer radiotherapy: A modern radiotherapy planning, treatment delivery and verification approach – A single institutional analysis

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Medical Imaging and Radiation Oncology Pub Date : 2024-10-18 DOI:10.1111/1754-9485.13738

Jack Mitchell, Amelia Campbell, Ming Zhao, Jennifer Harvey, Gang Tao Mai, Yoo Young Lee

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引用次数: 0

Abstract

Introduction

Radiotherapy plays a key role in the multidisciplinary management of oesophageal cancers across neoadjuvant, definitive and palliative settings. Improved precision in radiotherapy planning and delivery techniques have allowed treating disease with tighter margins reducing toxicity. In this study, we examine the appropriateness of current practice in defining the planning target volume (PTV).

Methods

This is a single institutional retrospective study of patients who received radiotherapy for oesophageal cancers using volumetric modulated arc therapy (VMAT) during 2020. All cone-beam computerised tomography (CBCT) scans were reviewed to assess whether PTV expansions appropriately accounted for tumour motion and interfractional variation.

Results

Of the 27 patients, 2 (7%), 5 (19%) and 20 (74%) had cervical, thoracic and distal/gastro-oesophageal junction (GOJ) disease, respectively. 16 (59%) had adenocarcinoma and 9 (33%) had squamous cell carcinoma. 9 of 20 distal/GOJ patients were planned and treated according to the institutional stomach filling protocol. 521/528 (98.7%) CBCTs demonstrated adequate target coverage. Cervical, thoracic and GOJ regions demonstrated adequate target coverage in 57/58, 96/97 and 368/373 CBCTs with median PTV expansions of 5, 7 and 7 mm, respectively. In four patients with GOJ disease, CBCT review identified five episodes where the target volume was insufficiently covered during the treatment course.

Conclusion

In this single institutional retrospective study, for the vast majority of patients, our institutional practice of defining PTV margins achieved satisfactory target treatment. The interfractional variations observed in patients with GOJ tumours due to target motion and variable gastric volume, highlights the role of further refinements to motion management techniques in this cohort.

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优化食道癌放疗的 PTV 边界：现代放射治疗计划、治疗实施和验证方法--单一机构分析。

简介放疗在食道癌的多学科治疗中发挥着关键作用，包括新辅助治疗、根治性治疗和姑息治疗。放疗计划和放疗技术精度的提高使得治疗疾病的边缘更紧密，从而降低了毒性。在本研究中，我们探讨了目前确定计划靶区（PTV）的做法是否恰当：这是一项单一机构的回顾性研究，研究对象是 2020 年期间接受容积调制弧线疗法（VMAT）放疗的食道癌患者。研究人员对所有锥形束计算机断层扫描（CBCT）扫描进行了审查，以评估PTV扩展是否适当考虑了肿瘤运动和点间变化：27名患者中，分别有2人（7%）、5人（19%）和20人（74%）患有颈部、胸部和远端/胃食管交界处（GOJ）疾病。16人（59%）患有腺癌，9人（33%）患有鳞状细胞癌。在20名远端/GOJ患者中，有9名患者是按照医院的胃填充方案进行计划和治疗的。521/528（98.7%）例 CBCT 显示目标覆盖充分。在57/58、96/97和368/373例CBCT中，颈部、胸部和GOJ区域显示出充分的靶点覆盖，PTV扩展中位数分别为5、7和7毫米。在4名患有GOJ疾病的患者中，CBCT检查发现了5次在治疗过程中靶区覆盖不足的情况：在这项单一机构的回顾性研究中，对于绝大多数患者来说，我们机构的PTV边缘界定方法都达到了令人满意的目标治疗效果。在GOJ肿瘤患者中观察到的因靶点移动和胃容积变化而导致的切缘间变化，强调了进一步完善移动管理技术在这类患者中的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Medical Imaging and Radiation Oncology 医学-核医学

CiteScore

3.30

自引率

6.20%

发文量

133

审稿时长

6-12 weeks

期刊介绍： Journal of Medical Imaging and Radiation Oncology (formerly Australasian Radiology) is the official journal of The Royal Australian and New Zealand College of Radiologists, publishing articles of scientific excellence in radiology and radiation oncology. Manuscripts are judged on the basis of their contribution of original data and ideas or interpretation. All articles are peer reviewed.