Document Detail


High-frequency jet ventilation for complete target immobilization and reduction of planning target volume in stereotactic high single-dose irradiation of stage I non-small cell lung cancer and lung metastases.
MedLine Citation:
PMID:  19910142     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To demonstrate the feasibility of complete target immobilization by means of high-frequency jet ventilation (HFJV); and to show that the saving of planning target volume (PTV) on the stereotactic body radiation therapy (SBRT) under HFJV, compared with SBRT with respiratory motion, can be predicted with reliable accuracy by computed tomography (CT) scans at peak inspiration phase. METHODS AND MATERIALS: A comparison regarding different methods for defining the PTV was carried out in 22 patients with tumors that clearly moved with respiration. A movement span of the gross tumor volume (GTV) was defined by fusing respiration-correlated CT scans. The PTV enclosed the GTV positions with a safety margin throughout the breathing cycle. To create a PTV from CT scans acquired under HFJV, the same margins were drawn around the immobilized target. In addition, peak inspiration phase CT images (PIP-CTs) were used to approximate a target immobilized by HFJV. RESULTS: The resulting HFJV-PTVs were between 11.6% and 45.4% smaller than the baseline values calculated as respiration-correlated CT-PTVs (median volume reduction, 25.4%). Tentative planning by means of PIP-CT PTVs predicted that in 19 of 22 patients, use of HFJV would lead to a reduction in volume of >or=20%. Using this threshold yielded a positive predictive value of 0.89, as well as a sensitivity of 0.94 and a specificity of 0.5. CONCLUSIONS: In all patients, SBRT under HFJV provided a reliable immobilization of the GTVs and achieved a reduction in PTVs, regardless of patient compliance. Tentative planning facilitated the selection of patients who could better undergo radiation in respiratory standstill, both with greater accuracy and lung protection.
Authors:
Peter Fritz; Hans-Jörg Kraus; Werner Mühlnickel; Volker Sassmann; Werner Hering; Konstantin Strauch
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2009-11-10
Journal Detail:
Title:  International journal of radiation oncology, biology, physics     Volume:  78     ISSN:  1879-355X     ISO Abbreviation:  Int. J. Radiat. Oncol. Biol. Phys.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-16     Completed Date:  2010-09-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7603616     Medline TA:  Int J Radiat Oncol Biol Phys     Country:  United States    
Other Details:
Languages:  eng     Pagination:  136-42     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Radiotherapy, St Marien-Krankenhaus, Siegen, Germany. p.h.fritz@t-online.de
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung / pathology,  radiography,  radiotherapy*
Feasibility Studies
Female
High-Frequency Jet Ventilation / methods*
Humans
Immobilization / methods*
Inhalation
Lung Neoplasms / pathology,  radiography,  radiotherapy*,  secondary
Male
Middle Aged
Movement
Patient Selection
Radiosurgery / methods*
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted / methods
Respiration*
Time Factors
Tomography, X-Ray Computed
Tumor Burden

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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