skip to main content

Title: SU-E-J-269: Assessing the Precision of Dose Delivery in CBCT-Guided Stereotactic Body Radiation Therapy for Lung and Soft Tissue Metastatic Lesions

Purpose: Ensuring reproducibility of target localization is critical to accurate stereotactic body radiation treatment (SBRT) for lung and soft tissue metastatic lesions. To characterize interfraction variability in set-up and evaluate PTV margins utilized for SBRT, daily CBCTs were used to calculate delivered target and OAR doses compared to those expected from planning. Methods: CBCT images obtained prior to each fraction of SBRT for a lung and thyroid metastatic lesion were evaluated. The target CTV/ITV and OARs on each of 8 CBCT data sets were contoured. Using MIM fusion software and Pinnacle{sup 3} RTP system, delivered dose distribution was reconstructed on each CBCT, utilizing translational shifts performed prior to treatment. Actual delivered vs. expected doses received by target CTV/ITV and adjacent critical structures were compared to characterize accuracy of pre-treatment translational shifts and PTV margins. Results: The planned CTV/ITV D95% and V100% were 4595cGy and 91.47% for the lung lesion, and 3010cGy and 96.34% for the thyroid lesion. Based on CBCT analysis, actual mean D95% and V100% for lung ITV were 4542±344.4cGy and 91.54±3.45%; actual mean D95% and V100% for thyroid metastasis CTV were 3005±25.98cGy and 95.20±2.522%. For the lung lesion, ipsilateral lung V20, heart V32 (cc) and spinal cord (.03more » cc) max were 110.15cc, 3.33cc, and 1680cGy vs. 110.27±14.79cc, 6.74±3.76cc, and 1711±46.56cGy for planned vs. delivered doses, respectively. For the thyroid metastatic lesion, esophagus V18, trachea (.03 cc) max, and spinal cord (.03 cc) max were 0.35cc, 2555cGy, and 850cGy vs. 0.16±0.13cc, 2147±367cGy, and 838±45cGy for planned vs. delivered treatments, respectively. Conclusion: Minimal variability in SBRT target lesion dose delivered based on pre-treatment CBCT-based translational shifts suggests tighter PTV margins may be considered to further decrease dose to surrounding critical structures. Guidelines for optimal target alignment during CBCT-guidance for lung and soft tissue metastatic lesions treated with SBRT are being established.« less
Authors:
; ; ; ; ; ;  [1]
  1. University of Toledo Medical Center, Toledo, OH (United States)
Publication Date:
OSTI Identifier:
22339948
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 41; Journal Issue: 6; Other Information: (c) 2014 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; ACCURACY; ANIMAL TISSUES; COMPUTER CODES; DOSES; ESOPHAGUS; HEART; IMAGES; LUNGS; METASTASES; PLANNING; RADIATION DOSE DISTRIBUTIONS; RADIOTHERAPY; RECOMMENDATIONS; SPINAL CORD; THYROID; TRACHEA