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Lower Esophagus Margin Implications Based On Rapid Computational Algorithm for SBRT

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M Cardenas

M Cardenas*, T Mazur , H Li , S Mutic , J Bradley , C Tsien , O Green , Washington University School of Medicine, Saint Louis, MO


SU-F-J-102 (Sunday, July 31, 2016) 3:00 PM - 6:00 PM Room: Exhibit Hall

To quantify inter-fraction esophagus-variation.

Computed tomography and daily on-treatment 0.3-T MRI data sets for 7 patients were analyzed using a novel Matlab-based (Mathworks, Natick, MA) rapid computational method.

Rigid registration was performed from the cricoid to the gastro-esophageal junction.
CT and MR-based contours were compared at slice intervals of 3mm. Variation was quantified by “expansion,” defined as additional length in any radial direction from CT contour to MR contour. Expansion computations were performed with 360° of freedom in each axial slice.
We partitioned expansions into left anterior, right anterior, right posterior, and left posterior quadrants (LA, RA, RP, and LP, respectively).

Sample means were compared by analysis of variance (ANOVA) and Fisher’s Protected Least Significant Difference test.

Fifteen fractions and 1121 axial slices from 7 patients undergoing SBRT for primary lung cancer (3) and metastatic lung disease (4) were analyzed, generating 41,970 measurements.

Mean LA, RA, RP, and LP expansions were 4.30±0.05 mm, 3.71±0.05mm, 3.17±0.07, and 3.98±0.06mm, respectively. 50.13% of all axial slices showed variation > 5 mm in one or more directions. Variation was greatest in lower esophagus with mean LA, RA, RP, and LP expansion (5.98±0.09 mm, 4.59±0.09 mm, 4.04±0.16 mm, and 5.41±0.16 mm, respectively). The difference was significant compared to mid and upper esophagus (p<.0001). The 95th percentiles of expansion for LA, RA, RP, LP , were 13.36 mm, 9.97 mm, 11.29 mm, and 12.19 mm, respectively.

Analysis of on-treatment MR imaging of the lower esophagus during thoracic SBRT suggests margin expansions of 13.36 mm LA, 9.97 mm RA, 11.29 mm RP, 12.19 mm LP would account for 95% of measurements. Our novel algorithm for rapid assessment of margin expansion for critical structures with 360° of freedom in each axial slice enables continuously adaptive patient-specific margins which may reduce overlap with high-dose regions.

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