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Title: Serial megavoltage CT imaging during external beam radiotherapy for non-small-cell lung cancer: Observations on tumor regression during treatment

Abstract

Purpose: The ability to obtain soft-tissue imaging in the treatment room, such as with megavoltage CT imaging, enables the observation of tumor regression during a course of external beam radiation therapy. In this current study, we report on the most extensive study looking at the rate of regression of non-small-cell lung cancers during a course of external beam radiotherapy by analyzing serial megavoltage CT images obtained on 10 patients. Methods and Materials: The analysis is performed on 10 patients treated with the Helical Tomotherapy Hi*Art device. All 10 patients had non-small-cell lung cancer. A total of 274 megavoltage CT sets were obtained on the 10 patients (average, 27 scans per patient; range, 9-35). All patients had at least a scan at beginning and at the end of treatment. The frequency of scanning was determined by the treating physician. The treatment was subsequently delivered with the Tomotherapy Hi*Art system. The gross tumor volumes (GTVs) were later contoured on each megavoltage CT scan, and tumor volumes were calculated. Although some patients were treated to draining nodal areas in addition to the primary tumor, only the primary GTVs were tracked. Response to treatment was quantified by the relative decrease in tumor volume overmore » time, i.e., elapsed days from the first day of therapy. The individual GTVs ranged from 5.9 to 737.2 cc in volume at the start of treatment. In 6 of the 10 patients, dose recalculations were also performed to document potential variations in delivered doses within the tumors. The megavoltage CT scans were used, and the planned treatment was recalculated on the daily images. The hypothesis was that dose deposited in the target would increase throughout the course of radiotherapy because of tumor shrinkage and subsequent decreasing attenuation. Specifically, the dose received by 95% of the GTV (D{sub 95}) was monitored over time for each of the 6 patients treated at M.D. Anderson Cancer Center Orlando. Results: Regression of all 10 lung tumors could be observed on the serial megavoltage CT scans. The decrease in volume was observed at a relatively constant rate throughout the treatments, with no obvious initial or final plateaus. For all 10 tumors, the average decrease in volume was 1.2% per day. However, individual tumor regression rates were observed with a range of 0.6% to 2.3% per day. The lowest rate of shrinkage was observed for the smallest lesion, and the highest rate was observed in the largest lesion. Of the 6 cases in which dose recalculations were performed, 5 demonstrated a small but noticeable gradual increase in deposited doses within the tumor, with the D{sub 95} increases ranging from 0.02% to 0.1% per day. Conclusion: With the advent of in-room soft-tissue imaging techniques such as megavoltage CT imaging with a helical tomotherapy unit, daily documentation of the status of a grossly visible targeted tumor becomes possible. The current study demonstrated that tumor regression can be documented for patients with non-small-cell lung cancer treated with helical tomotherapy. Clinical correlations between the observations made during the course of treatment and ultimate outcomes, e.g. local control, should be investigated.« less

Authors:
 [1];  [2];  [3];  [3];  [3];  [3];  [3]
  1. Department of Radiation Oncology, M.D. Anderson Cancer Center Orlando, Orlando, FL (United States). E-mail: kupelian@orhs.org
  2. Department of Radiation Oncology, Thompson Cancer Survival Center, Knoxville, TN (United States)
  3. Department of Radiation Oncology, M.D. Anderson Cancer Center Orlando, Orlando, FL (United States)
Publication Date:
OSTI Identifier:
20706244
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 63; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2005.04.046; PII: S0360-3016(05)00818-7; Copyright (c) 2005 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ATTENUATION; CARCINOMAS; COMPUTERIZED TOMOGRAPHY; DOCUMENTATION; IMAGES; LUNGS; PATIENTS; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Kupelian, Patrick A., Ramsey, Chester, Meeks, Sanford L., Willoughby, Twyla R., Forbes, Alan, Wagner, Thomas H., and Langen, Katja M. Serial megavoltage CT imaging during external beam radiotherapy for non-small-cell lung cancer: Observations on tumor regression during treatment. United States: N. p., 2005. Web. doi:10.1016/j.ijrobp.2005.04.046.
Kupelian, Patrick A., Ramsey, Chester, Meeks, Sanford L., Willoughby, Twyla R., Forbes, Alan, Wagner, Thomas H., & Langen, Katja M. Serial megavoltage CT imaging during external beam radiotherapy for non-small-cell lung cancer: Observations on tumor regression during treatment. United States. doi:10.1016/j.ijrobp.2005.04.046.
Kupelian, Patrick A., Ramsey, Chester, Meeks, Sanford L., Willoughby, Twyla R., Forbes, Alan, Wagner, Thomas H., and Langen, Katja M. Tue . "Serial megavoltage CT imaging during external beam radiotherapy for non-small-cell lung cancer: Observations on tumor regression during treatment". United States. doi:10.1016/j.ijrobp.2005.04.046.
@article{osti_20706244,
title = {Serial megavoltage CT imaging during external beam radiotherapy for non-small-cell lung cancer: Observations on tumor regression during treatment},
author = {Kupelian, Patrick A. and Ramsey, Chester and Meeks, Sanford L. and Willoughby, Twyla R. and Forbes, Alan and Wagner, Thomas H. and Langen, Katja M.},
abstractNote = {Purpose: The ability to obtain soft-tissue imaging in the treatment room, such as with megavoltage CT imaging, enables the observation of tumor regression during a course of external beam radiation therapy. In this current study, we report on the most extensive study looking at the rate of regression of non-small-cell lung cancers during a course of external beam radiotherapy by analyzing serial megavoltage CT images obtained on 10 patients. Methods and Materials: The analysis is performed on 10 patients treated with the Helical Tomotherapy Hi*Art device. All 10 patients had non-small-cell lung cancer. A total of 274 megavoltage CT sets were obtained on the 10 patients (average, 27 scans per patient; range, 9-35). All patients had at least a scan at beginning and at the end of treatment. The frequency of scanning was determined by the treating physician. The treatment was subsequently delivered with the Tomotherapy Hi*Art system. The gross tumor volumes (GTVs) were later contoured on each megavoltage CT scan, and tumor volumes were calculated. Although some patients were treated to draining nodal areas in addition to the primary tumor, only the primary GTVs were tracked. Response to treatment was quantified by the relative decrease in tumor volume over time, i.e., elapsed days from the first day of therapy. The individual GTVs ranged from 5.9 to 737.2 cc in volume at the start of treatment. In 6 of the 10 patients, dose recalculations were also performed to document potential variations in delivered doses within the tumors. The megavoltage CT scans were used, and the planned treatment was recalculated on the daily images. The hypothesis was that dose deposited in the target would increase throughout the course of radiotherapy because of tumor shrinkage and subsequent decreasing attenuation. Specifically, the dose received by 95% of the GTV (D{sub 95}) was monitored over time for each of the 6 patients treated at M.D. Anderson Cancer Center Orlando. Results: Regression of all 10 lung tumors could be observed on the serial megavoltage CT scans. The decrease in volume was observed at a relatively constant rate throughout the treatments, with no obvious initial or final plateaus. For all 10 tumors, the average decrease in volume was 1.2% per day. However, individual tumor regression rates were observed with a range of 0.6% to 2.3% per day. The lowest rate of shrinkage was observed for the smallest lesion, and the highest rate was observed in the largest lesion. Of the 6 cases in which dose recalculations were performed, 5 demonstrated a small but noticeable gradual increase in deposited doses within the tumor, with the D{sub 95} increases ranging from 0.02% to 0.1% per day. Conclusion: With the advent of in-room soft-tissue imaging techniques such as megavoltage CT imaging with a helical tomotherapy unit, daily documentation of the status of a grossly visible targeted tumor becomes possible. The current study demonstrated that tumor regression can be documented for patients with non-small-cell lung cancer treated with helical tomotherapy. Clinical correlations between the observations made during the course of treatment and ultimate outcomes, e.g. local control, should be investigated.},
doi = {10.1016/j.ijrobp.2005.04.046},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 63,
place = {United States},
year = {Tue Nov 15 00:00:00 EST 2005},
month = {Tue Nov 15 00:00:00 EST 2005}
}