Lung Stereotactic Body Radiotherapy Using an Abdominal Compression System, “Air-Bag System”

Hideharu  Miura; Ryoong-Jin  Oh; Norihisa  Masai; Hiroya  Shiomi; Kouichi  Yamada; Toshihiko  Inoue

doi:10.4236/ijmpcero.2014.32015

Hideharu Miura^*, Ryoong-Jin Oh, Norihisa Masai, Hiroya Shiomi, Kouichi Yamada, Toshihiko Inoue

Abstract: We investigated respiratory tumor motion in lung stereotactic body radiotherapy (SBRT) with use of the “Air-Bag System”. 114 patients underwent four-dimensional (4D) computed tomography (CT) from October 2010 to April 2012. Gross tumor volume (GTV) was 8.1 ± 11.0 cc (range 0.3 - 77.5 cc). The tumor site was the upper and middle lobes in 62 cases, and lower lobe in 52 cases. The Air-Bag SystemTM consists of an inelastic air bag connected to a second smaller elastic air bag. The inelastic air bag is placed between the patient’s body surface and a HipFix and is secured by pressure adjustment via the elastic air bag. To assess respiratory tumor motion, the centroid of the tumor position is measured in the left-right, anterior-posterior, and caudal-cranial directions using the iPlan RT DoseTM treatment planning system. Respiratory tumor motion vector for patients with upper/middle and lower lobe tumors was 3.0 ± 2.2 mm (range, 0.4 - 11.7 mm) and 6.5 ± 4.6 mm (range, 0.4 - 22.0 mm) respectively, with this difference being significant (p < 0.05). Mean respiratory tumor motion for all patients was 0.9 ± 0.6 mm (range, 0.1 - 3.6 mm) in the left-right direction, 1.5 ± 1.1 mm (range, 0.1 - 5.7 mm) in the anterior-posterior direction, 4.1 ± 4.0 mm (range, 0.1 - 21.4 mm) in the caudal-cranial direction, and 4.7 ± 4.0 mm (range, 0.4 - 22.0 mm) overall. The Air-Bag System is expected to be provided an effective reduction in the motion of lung tumors.

Keywords: Stereotactic Body Radiotherapy, Lung Cancer, Tumor Motion, Abdominal Compression, Air-Bag System

Cite this paper: Miura, H. , Oh, R. , Masai, N. , Shiomi, H. , Yamada, K. and Inoue, T. (2014) Lung Stereotactic Body Radiotherapy Using an Abdominal Compression System, “Air-Bag System”. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 3, 98-106. doi: 10.4236/ijmpcero.2014.32015.

References

[1] Keall, P.J., Mageras, G.S., Balter, J.M., et al. (2006) The Management of Respiratory Motion in Radiation Oncology Report of AAPM Task Group 76. Medical Physics, 33, 3874-3900.
http://dx.doi.org/10.1118/1.2349696

[2] Mori, S., Endo, M., Komatsu, S., Yashiro, T., Kandatsu, S. and Baba, M. (2007) Four-Dimensional Measurement of Lung Tumor Displacement Using 256 Multi Slice CT Scanner. Lung Cancer, 56, 56-67.
http://dx.doi.org/10.1016/j.lungcan.2006.11.011

[3] Stevens, C.W., Munden, R.F., Forster, K.M., et al. (2001) Respiratory-Driven Lung Tumor Motion Is Independent of Tumor Size, Tumor Location, and Pulmonary Function. International Journal of Radiation Oncology, Biology, Physics, 51, 62-68.

[4] Chen, Q.S., Weinhous, M.S., Deibel, F.C., Ciezki, J.P. and Macklis, R.M. (2001) Fluoroscopic Study of Tumor Motion Due to Breathing: Facilitating Precise Radiation Therapy for Lung Cancer Patients. Medical Physics, 28, 1850-1856.
http://dx.doi.org/10.1118/1.1398037

[5] Guckenberger, M., Meyer, J., Wilbert, J., et al. (2006) Cone-Beam CT Based Image-Guidance for Extracranial Stereotactic Radiotherapy of Intrapulmonary Tumors. Acta Oncologica, 45, 897-906.
http://dx.doi.org/10.1080/02841860600904839

[6] ICRU (1993) Prescribing, Recording, and Reporting Photon Beam Therapy. ICRU Report Volume 50, International Commission on Radiation Units and Measurements, Bethesda.

[7] Seppenwoolde, Y., Lebesque, J.V., De Jaeger, K., et al. (2003) Comparing Different NTCP Models That Predict the Incidence of Radiation Pneumonitis. Normal Tissue Complication Probability. International Journal of Radiation Oncology, Biology, Physics, 55, 724-735.

[8] Mageras, G.S. and Yorke, E. (2004) Deep Inspiration Breath Hold and Respiratory Gating Strategies for Reducing Organ Motion in Radiation Treatment. Seminars in Radiation Oncology, 14, 65-75.
http://dx.doi.org/10.1053/j.semradonc.2003.10.009

[9] Negoro, Y., Nagata, Y., Aoki, T., et al. (2001) The Effectiveness of an Immobilization Device in Conformal Radiotherapy for Lung Tumor: Reduction of Respiratory Tumor Movement and Evaluation of the Daily Setup Accuracy. International Journal of Radiation Oncology, Biology, Physics, 50, 889-898.

[10] Miura, H., Masai, N., Oh, R.J., Shiomi, H., Sasaki, J. and Inoue, T. (2013) Approach to Dose Prescription of the Gross Tumor Volume for Lung Cancer with Respiratory Tumor Motion. Journal of Radiation Research, 54, 140-145.
http://dx.doi.org/10.1093/jrr/rrs054

[11] Hanley, J., Debois, M.M., Mah, D., et al. (1999) Deep Inspiration Breath-Hold Technique for Lung Tumors: The Potential Value of Target Immobilization and Reduced Lung Density in Dose Escalation. International Journal of Radiation Oncology, Biology, Physics, 45, 603-611.

[12] Liu, H.H., Balter, P., Tutt, T., et al. (2007) Assessing Respiration-Induced Tumor Motion and Internal Target Volume Using Four-Dimensional Computed Tomography for Radiotherapy of Lung Cancer. International Journal of Radiation Oncology, Biology, Physics, 68, 531-540.

[13] Han, K., Cheung, P., Basran, P.S., Poon, I., Yeung, L. and Lochray, F. (2010) A Comparison of Two Immobilization Systems for Stereotactic Body Radiation Therapy of Lung Tumors. Radiotherapy & Oncology, 95, 103-108.
http://dx.doi.org/10.1016/j.radonc.2010.01.025

[14] Ko, Y.E., Suh, Y., Ahn, S.D., et al. (2005) Immobilization Effect of Air-Injected Blanket (AIB) for Abdomen Fixation. Medical Physics, 32, 3363-3366.
http://dx.doi.org/10.1118/1.2047783

[15] Seppenwoolde, Y., Shirato, H., Kitamura, K., et al. (2002) Precise and Real-Time Measurement of 3D Tumor Motion in Lung Due to Breathing and Heartbeat, Measured during Radiotherapy. International Journal of Radiation Oncology, Biology, Physics, 53, 822-834.

[16] Onishi, H., Kawakami, H., Marino, K., et al. (2010) A Simple Respiratory Indicator for Irradiation during Voluntary Breath Holding: A One-Touch Device without Electronic Materials. Radiology, 255, 917-923.
http://dx.doi.org/10.1148/radiol.10090890

[17] George, R., Ramakrishnan, V., Siebers, J.V., Chung, T.D. and Keall, P.J. (2006) Investigation of Patient, Tumour and Treatment Variables Affecting Residual Motion for Respiratory-Gated Radiotherapy. Physics & Medicine in Biology, 51, 5305-5319.
http://dx.doi.org/10.1088/0031-9155/51/20/015

[18] George, R., Chung, T.D., Vedam, S.S., et al. (2006) Audio-Visual Biofeedback for Respiratory-Gated Radiotherapy: Impact of Audio Instruction and Audio-Visual Biofeedback on Respiratory-Gated Radiotherapy. International Journal of Radiation Oncology, Biology, Physics, 65, 924-933.

[19] Eccles, C.L., Patel, R., Simeonov, A.K., Lockwood, G., Haider, M. and Dawson, L.A. (2011) Comparison of Liver Tumor Motion with and without Abdominal Compression Using Cine-Magnetic Resonance Imaging. International Journal of Radiation Oncology, Biology, Physics, 79, 602-608.