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Use of Volumetric Indices to Study the Viability of Respiratory Gating in Conjunction with Abdominal Compression in the Management of Non-Small Cell Lung Cancer Tumors Using Stereotactic Body Radiation Therapy Under the Conditions of Controlled Breathing

H Malhotra

H Malhotra*, J Gomez , Roswell Park Cancer Institute, Buffalo, NY


SU-G-JeP3-13 (Sunday, July 31, 2016) 5:00 PM - 5:30 PM Room: ePoster Theater

Purpose: AAPM TG-76 report advises lung patients experiencing tumor motion >5mm to use some form of motion management with even smaller limit for complex/special procedures like SBRT. Generally, either respiratory gating or abdominal compression is used for motion management. In this retrospective study, we are using an innovative index, Volumetric Indices (VI) = (GTVnn AND GTV₅₀₊Xmm)/(GTVnn) to quantify how much of the tumor remains within 1, 2, and 3mm margins throughout the breathing cycle using GTV₅₀₊Xmm margin on GTV₅₀[nn=0,10,20,...90]. Using appropriate limits, VI can provide tumor motion information and to check if RPM gates could have been used in conjunction with abdominal compression to better manage tumor motion.

Methods: 64 SBRT patients with a total of 67 lung tumors were studied. 4DCT scans were taken, fully capturing tumor motion throughout the 10 phases of the breathing cycle. For each phase, Gross Tumor Volume (GTV) was segmented and appropriates structures were defined to determine VI values. For the 2mm margin, VI values less than 0.95 for peripheral lesions and 0.97 for central lesions indicate tumor movement greater than 4mm. VI values for 1mm and 3mm margins were also analyzed signifying tumor motion of 2mm & 6mm, respectively.

Results: Of the 64 patients, 35 (55%) had motion greater than 4mm & could have benefited from respiratory gating. For 5/8 (63%) middle lobe lesions, 21/27 (78%) lower lobe lesions, and 10/32 (31%) upper lobe lesions, gating could have resulted in smaller ITV. 32/55 (58%) peripheral lesions and 4/12 (33%) central lesions could have had gating. Average ITV decreased by 1.25cc (11.43%) and average VI increased by 0.11.

Conclusion: Out of 64 patients, 55% exhibited motion greater than 4mm even with abdominal compression. Even with abdominal-compression, lung tumors can move >4mm as the degree of pressure which a patient can tolerate, is patient specific.

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