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Title: Combined Recipe for Clinical Target Volume and Planning Target Volume Margins

Purpose: To develop a combined recipe for clinical target volume (CTV) and planning target volume (PTV) margins. Methods and Materials: A widely accepted PTV margin recipe is M{sub geo} = aΣ{sub geo} + bσ{sub geo}, with Σ{sub geo} and σ{sub geo} standard deviations (SDs) representing systematic and random geometric uncertainties, respectively. On the basis of histopathology data of breast and lung tumors, we suggest describing the distribution of microscopic islets around the gross tumor volume (GTV) by a half-Gaussian with SD Σ{sub micro}, yielding as possible CTV margin recipe: M{sub micro} = ƒ(N{sub i}) × Σ{sub micro}, with N{sub i} the average number of microscopic islets per patient. To determine ƒ(N{sub i}), a computer model was developed that simulated radiation therapy of a spherical GTV with isotropic distribution of microscopic disease in a large group of virtual patients. The minimal margin that yielded D{sub min} <95% in maximally 10% of patients was calculated for various Σ{sub micro} and N{sub i}. Because Σ{sub micro} is independent of Σ{sub geo}, we propose they should be added quadratically, yielding for a combined GTV-to-PTV margin recipe: M{sub GTV-PTV} = √([aΣ{sub geo}]{sup 2} + [ƒ(N{sub i})Σ{sub micro}]{sup 2}) + bσ{sub geo}. This was validated bymore » the computer model through numerous simultaneous simulations of microscopic and geometric uncertainties. Results: The margin factor ƒ(N{sub i}) in a relevant range of Σ{sub micro} and N{sub i} can be given by: ƒ(N{sub i}) = 1.4 + 0.8log(N{sub i}). Filling in the other factors found in our simulations (a = 2.1 and b = 0.8) yields for the combined recipe: M{sub GTV-PTV} = √((2.1Σ{sub geo}){sup 2} + ([1.4 + 0.8log(N{sub i})] × Σ{sub micro}){sup 2}) + 0.8σ{sub geo}. The average margin difference between the simultaneous simulations and the above recipe was 0.2 ± 0.8 mm (1 SD). Calculating M{sub geo} and M{sub micro} separately and adding them linearly overestimated PTVs by on average 5 mm. Margin recipes based on tumor control probability (TCP) instead of D{sub min} criteria yielded similar results. Conclusions: A general recipe for GTV-to-PTV margins is proposed, which shows that CTV and PTV margins should be added in quadrature instead of linearly.« less
 [1] ;  [2] ;  [1] ; ;  [3] ;  [1] ;  [3]
  1. Department of Radiation Oncology, Champalimaud Foundation, Lisboa (Portugal)
  2. Department of Radiology, University Medical Center Utrecht, Utrecht (Netherlands)
  3. Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands)
Publication Date:
OSTI Identifier:
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 88; Journal Issue: 3; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States