A Pilot Study of Synchronization of Respiration-Induced Motions in the Duodenum and Stomach for the Primary Tumor in Radiation Therapy for Pancreatic Cancer Using 4-Dimensional Computed Tomography

Rei Umezawa, Akihisa Wakita, Yoshiyuki Katsuta, Yoshinori Ito, Satoshi Nakamura, Hiroyuki Okamoto, Noriyuki kadoya, Kana Takahashi, Koji Inaba, Naoya Murakami, Hiroshi Igaki, Keiichi Jingu, Jun Itami

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Abstract

Purpose: We investigated the synchronization of respiration-induced motions at the primary tumor and organs at risk at radiation planning for pancreatic cancer. Methods and Materials: Four-dimensional computed tomography images were acquired under the condition of shallow free breathing in patients with pancreatic cancer. The gross tumor volume (GTV), duodenum (DU), and stomach (ST) were contoured. The center of mass was computed for each 4-dimensional volume of interest. The respiration dependence of coordinates for the center of each volume of interest was computed relative to its location at the 50% (maximum exhalation) phase. Based on the shift of the GTV, we investigated the synchronization of respiration-induced motions between each contouring target. We examined the differences in the volume averaged dose to the ST and DU in each respiratory phase. Results: Nine patients with pancreatic cancer were analyzed in this study. The mean maximum 3-dimensional excursions at the GTV, DU, and ST were 9.6, 9.8, and 11.4 mm, respectively. At phase 0% and 90% (inhale phases), mean distance changes in the positional relationship with the GTV were 0.3 and 0.7 mm respectively for the DU and −2.5 and −2.4 mm respectively for the ST. There was no significant respiration associated change (RAC) between each respiratory phase in the DU (P = .568), and there was a significant RAC in the ST (P < .001). There was a significant RAC of the volume averaged dose to the ST (P = .023). Conclusions: Our results indicate that the DU but not the ST might move synchronously with GTV due to respiration.

Original languageEnglish
Article number100730
JournalAdvances in Radiation Oncology
Volume6
Issue number4
DOIs
Publication statusPublished - 2021 Jul 1

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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