Document Detail

Real-time Four-dimensional Radiotherapy for Lung Cancer.
MedLine Citation:
PMID:  21954991     Owner:  NLM     Status:  Publisher    
Respiratory motion considerably influences dose distribution and thus clinical outcomes in radiotherapy for lung cancer. Breath-holding, breath-coaching, respiratory gating with external surrogates, and mathematical predicting models all have inevitable uncertainty due to the unpredictable variations of internal tumor motion. The amplitude of the same tumor can vary with standard deviations > 5mm occurring in 23% of T1-2N0M0 non-small cell lung cancers. Residual motion varied 1 to 6 mm (95(th) percentile) for the 40% duty cycle of respiratory gating with external surrogates. The four-dimensional computed tomography are all vulnerable to problems relating to the external surrogates. Real-time four-dimensional radiotherapy (4DRT), where the temporal changes in anatomy during the delivery of radiotherapy are explicitly considered in real-time, is emerging as a new method to reduce these known sources of uncertainty. Fluoroscopic real-time tumor-tracking technology using internal fiducial markers near the tumor has ± 2 mm accuracy and has achieved promising clinical results when used with x-ray therapy. Instantaneous irradiation based on real-time verification of internal fiducial markers is considered the minimal requisite for real-time 4DRT of lung cancers at present. Real-time tracking radiotherapy using gamma rays from positron emitters in tumors is in the pre-clinical research stage but has been successful in experiments in small animals. Real-time tumor-tracking via spot-scanning proton beam therapy has the capability to cure large lung cancers in motion and is expected to be the next-generation real-time 4DRT.
Hiroki Shirato; Rikiya Onimaru; Masayori Ishikawa; Jun-Ichi Kaneko; Tsuguhide Takeshima; Kenta Mochizuki; Shinichi Shimizu; Kikuo Umegaki
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-29
Journal Detail:
Title:  Cancer science     Volume:  -     ISSN:  1349-7006     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101168776     Medline TA:  Cancer Sci     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 Japanese Cancer Association.
Department of Radiation Medicine Medical Physics, Graduate School of Medicine Division of Quantum Science and Engineering, Graduate School of Engineering, Hokkaido University, Sapporo Japan.
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