Abstract
Background
Respiratory motion may compromise the dose delivery accuracy in liver stereotactic body radiation therapy (SBRT). Motion management can improve treatment delivery. However, external surrogate signal may be unstable and inaccurate. This study reports the first case of liver SBRT based on internal electromagnetic motion monitoring (Calypso, Varian Medical Systems, USA) in China.
Materials and methods
The patient with a primary liver cancer was treated with respiratory-gated SBRT guided by three implanted electromagnetic transponders. The treatment was carried out in breath-hold end-exhale with beam-on when the centroid of the three transponders drifted within 5 mm (left–right (LR), anterior–posterior (AP) and cranio-caudal (CC) directions) from the planned position. The motion monitoring treatments were delivered in breath-hold end-exhale mode with the energy of 6 MV in FFF mode with 1200 monitor units (MU) per minute. For each fraction, QA results, intertransponder distances, geometric checks as well as tumor motion logs were explicitly recorded.
Results
Comparing with the plan data, distance variances between each two transponders were − 0.56 ± 0.32 mm, 0.17 ± 0.33 mm and − 0.82 ± 0.68 mm. Geometric residual, the pitch, roll and yaw angles were 0.48 ± 0.21 mm (threshold 2.0 mm), 2.17° ± 1.85° (threshold 10°), − 2.42° ± 1.51° (threshold 10°) and 1.67° ± 1.07° (threshold 10°), respectively. The delivery time of the five fields were 13.8 s, 13.1 s, 11.2 s, 11.6 s, and 11.6 s with the average value of 12.3 ± 1.1 s. Treatment duration of each fraction ranged from 6.2 to 21.4 min, with the average value of 11.3 ± 5.0 min.
Conclusions
The first case of liver SBRT patient of China based on internal electromagnetic motion monitoring was performed. The system had a high tracking accuracy, and it did not delay the treatment time. In addition, the patient did not show any severe side effects except for grade I myelotoxicity. The internal electromagnetic motion monitoring system provides a real-time and direct way to track liver tumor targets.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bertholet J, Toftegaard J, Hansen R, Worm ES, Wan H, Parikh PJ et al (2018) Automatic online and real-time tumour motion monitoring during stereotactic liver treatments on a conventional linac by combined optical and sparse monoscopic imaging with kilovoltage X-rays (COSMIK). Phys Med Biol 63(5):055012. https://doi.org/10.1088/1361-6560/aaae8b (Epub 2018/03/09, PubMed PMID: 29516868)
Brock J, McNair HA, Panakis N, Symonds-Tayler R, Evans PM, Brada M (2011) The use of the active breathing coordinator throughout radical non-small-cell lung cancer (NSCLC) radiotherapy. Int J Radiat Oncol Biol Phys 81(2):369–375. https://doi.org/10.1016/j.ijrobp.2010.05.038 (Epub 2010/08/31, PubMed PMID: 20800379)
Colvill E, Krieger M, Bosshard P, Steinacher P, Rohrer Schnidrig BA, Parkel T et al (2020) Anthropomorphic phantom for deformable lung and liver CT and MR imaging for radiotherapy. Phys Med Biol 65(7):07NT2. https://doi.org/10.1088/1361-6560/ab7508 (Epub 2020/02/12, PubMed PMID: 32045898)
Dai ZH, Zhang BL, Zhu L, Zhu YH, Yang G, Cai CY et al (2018) Evaluation of the accuracy of Calypso 4D electromagnetic localization system in Edge accelerator. Chin J Med Phys 35(5):497–502. https://doi.org/10.3969/j.issn.1005-202X.2018.05.001
Dai Z, Zhang H, Xie Y, Zhu L, Zhang B, Cai C et al (2019) Validation of geometric and dosimetric accuracy of edge accelerator gating with electromagnetic tracking: a phantom study. IEEE Access 7:127693–127702. https://doi.org/10.1109/access.2019.2934858
Fernandes AT, Apisarnthanarax S, Yin L, Zou W, Rosen M, Plastaras JP et al (2015) Comparative assessment of liver tumor motion using cine-magnetic resonance imaging versus 4-dimensional computed tomography. Int J Radiat Oncol Biol Phys 91(5):1034–1040. https://doi.org/10.1016/j.ijrobp.2014.12.048 (Epub 2015/04/04, PubMed PMID: 25832694)
Ge J, Santanam L, Yang D, Parikh PJ (2013) Accuracy and consistency of respiratory gating in abdominal cancer patients. Int J Radiat Oncol Biol Phys 85(3):854–861. https://doi.org/10.1016/j.ijrobp.2012.05.006 (Epub 2012/06/22, PubMed PMID: 22717241)
George R, Chung TD, Vedam SS, Ramakrishnan V, Mohan R, Weiss E et al (2006) Audio-visual biofeedback for respiratory-gated radiotherapy: impact of audio instruction and audio-visual biofeedback on respiratory-gated radiotherapy. Int J Radiat Oncol Biol Phys 65(3):924–933. https://doi.org/10.1016/j.ijrobp.2006.02.035 (Epub 2006/06/06, PubMed PMID: 16751075)
Herrmann H, Seppenwoolde Y, Georg D, Widder J (2019) Image guidance: past and future of radiotherapy. Radiologe 59(Suppl 1):21–27. https://doi.org/10.1007/s00117-019-0573-y (Epub 2019/07/28, PubMed PMID: 31346650; PubMed Central PMCID: PMCPMC6914710)
James J, Cetnar A, Nguyen V, Wang B (2015) MO-F-CAMPUS-J-02: commissioning of radiofrequency tracking for gated SBRT of the liver using novel motion system. Med Phys 42(6Part30):3582. https://doi.org/10.1118/1.4925482
James J, Cetnar A, Dunlap NE, Huffaker C, Nguyen VN, Potts M et al (2016) Technical note: validation and implementation of a wireless transponder tracking system for gated stereotactic ablative radiotherapy of the liver. Med Phys 43(6):2794–2801. https://doi.org/10.1118/1.4948669 (Epub 2016/06/10, PubMed PMID: 27277027)
Kirilova A, Lockwood G, Choi P, Bana N, Haider MA, Brock KK et al (2008) Three-dimensional motion of liver tumors using cine-magnetic resonance imaging. Int J Radiat Oncol Biol Phys 71(4):1189–1195. https://doi.org/10.1016/j.ijrobp.2007.11.026 (Epub 2008/02/09, PubMed PMID: 18258378)
Kupelian P, Willoughby T, Mahadevan A, Djemil T, Weinstein G, Jani S et al (2007) Multi-institutional clinical experience with the Calypso system in localization and continuous, real-time monitoring of the prostate gland during external radiotherapy. Int J Radiat Oncol Biol Phys 67(4):1088–1098. https://doi.org/10.1016/j.ijrobp.2006.10.026 (Epub 2006/12/26, PubMed PMID: 17187940)
Lagendijk JJ, Raaymakers BW, Van den Berg CA, Moerland MA, Philippens ME, van Vulpen M (2014) MR guidance in radiotherapy. Phys Med Biol 59(21):349–369. https://doi.org/10.1088/0031-9155/59/21/R349 (Epub 2014/10/17, PubMed PMID: 25322150)
Lee TK, Ewald A, Schultz T, Park SY (2014) SU-E-J-253: evaluation of 4DCT images with correlation of RPM signals to tumor motion for respiratory-gated radiotherapy. Med Phys 41(6Part10):216. https://doi.org/10.1118/1.4888307
Li J, Pollack A, Horwitz E, Buyyounouski M, Price R, Ma C (2007) Clinical experience on localization and real-time tracking of the prostate during external radiotherapy using Calypso® 4D localization system. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2007.07.342
Li Y, Netherton T, Nitsch PL, Balter PA, Gao S, Klopp AH et al (2018) Normal tissue doses from MV image-guided radiation therapy (IGRT) using orthogonal MV and MV-CBCT. J Appl Clin Med Phys 19(3):52–57. https://doi.org/10.1002/acm2.12276 (Epub 2018/03/04, PubMed PMID: 29500856; PubMed Central PMCID: PMCPMC5978715)
Ma Z, Zhang W, Su Y, Liu P, Pan Y, Zhang G et al (2018) Optical surface management system for patient positioning in interfractional breast cancer radiotherapy. Biomed Res Int 2018:6415497. https://doi.org/10.1155/2018/6415497 (Epub 2018/03/08, PubMed PMID: 29511688; PubMed Central PMCID: PMCPMC5817315)
Montanaro T, Nguyen DT, Keall PJ, Booth J, Caillet V, Eade T et al (2018) A comparison of gantry-mounted X-ray-based real-time target tracking methods. Med Phys 45(3):1222–1232. https://doi.org/10.1002/mp.12765 (Epub 2018/01/25, PubMed PMID: 29363760)
Poulsen PR, Worm ES, Hansen R, Larsen LP, Grau C, Hoyer M (2015) Respiratory gating based on internal electromagnetic motion monitoring during stereotactic liver radiation therapy: first results. Acta Oncol 54(9):1445–1452. https://doi.org/10.3109/0284186X.2015.1062134 (Epub 2015/07/23, PubMed PMID: 26198651)
Quinn A, Holloway L, Cutajar D, Hardcastle N, Rosenfeld A, Metcalfe P (2011) Megavoltage cone beam CT near surface dose measurements: potential implications for breast radiotherapy. Med Phys 38(11):6222–6227. https://doi.org/10.1118/1.3641867 (Epub 2011/11/04, PubMed PMID: 22047387)
Sawant A, Smith RL, Venkat RB, Santanam L, Cho B, Poulsen P et al (2009) Toward submillimeter accuracy in the management of intrafraction motion: the integration of real-time internal position monitoring and multileaf collimator target tracking. Int J Radiat Oncol Biol Phys 74(2):575–582. https://doi.org/10.1016/j.ijrobp.2008.12.057 (Epub 2009/03/31, PubMed PMID: 19327907)
Shimohigashi Y, Toya R, Saito T, Ikeda O, Maruyama M, Yonemura K et al (2017) Tumor motion changes in stereotactic body radiotherapy for liver tumors: an evaluation based on four-dimensional cone-beam computed tomography and fiducial markers. Radiat Oncol 12(1):61. https://doi.org/10.1186/s13014-017-0799-7 (Epub 2017/03/25, PubMed PMID: 28335794; PubMed Central PMCID: PMCPMC5364670)
Shinohara ET, Kassaee A, Mitra N, Vapiwala N, Plastaras JP, Drebin J et al (2012) Feasibility of electromagnetic transponder use to monitor inter- and intrafractional motion in locally advanced pancreatic cancer patients. Int J Radiat Oncol Biol Phys 83(2):566–573. https://doi.org/10.1016/j.ijrobp.2011.07.025 (Epub 2011/11/22, PubMed PMID: 22099029)
Skouboe S, Poulsen PR, Muurholm CG, Worm E, Hansen R, Hoyer M et al (2019) Simulated real-time dose reconstruction for moving tumors in stereotactic liver radiotherapy. Med Phys 46(11):4738–4748. https://doi.org/10.1002/mp.13792 (Epub 2019/08/31, PubMed PMID: 31468543)
Sweeney RA, Seubert B, Stark S, Homann V, Müller G, Flentje M et al (2012) Accuracy and inter-observer variability of 3D versus 4D cone-beam CT based image-guidance in SBRT for lung tumors. Radiat Oncol 7(1):81. https://doi.org/10.1186/1748-717X-7-81
Velec M, Tadic T, Xie J, Moseley JL, Patel T, Milosevic M et al (2019) Deformable dose accumulation for hybrid CBCT-MRI guided adaptive radiotherapy for cervix cancer. Int J Radiat Oncol Biol Phys 105(1):S252. https://doi.org/10.1016/j.ijrobp.2019.06.376
Worm ES, Hoyer M, Hansen R, Larsen LP, Weber B, Grau C et al (2018) A prospective cohort study of gated stereotactic liver radiation therapy using continuous internal electromagnetic motion monitoring. Int J Radiat Oncol Biol Phys 101(2):366–375. https://doi.org/10.1016/j.ijrobp.2018.02.010 (Epub 2018/03/22, PubMed PMID: 29559289)
Zheng C, Dai JR (2013) Comparison of algorithms for localizing prostate tumor via monoscopic X-ray imaging. Chin J Med Phys 30(6):4491–4496. https://doi.org/10.3969/j.issn.1005-202X.2013.06.006
Acknowledgements
The authors thank the therapist group of the Radiotherapy Department of Jiangsu Cancer Hospital for their helpful advices and selfless assistance. The authors thank the School of Biomedical Science and Medical Engineering for their help in designing the video signal synchronizing device. The authors also thank Miss Vicky Chen for her careful proofreading.
Funding
This study was funded by China Postdoctoral Science Foundation (2018M632263), Southeast University—Nanjing Medical University Cooperative Research Project (2242018K3DN22) and Postdoctoral Foundation of Jiangsu Institute of Cancer Research (SZL201715).
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Ethical approval
All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Mu, Z., Wang, Q., Guo, C. et al. The first internal electromagnetic motion monitoring implementation for stereotactic liver radiotherapy in China: procedures and preliminary results. J Cancer Res Clin Oncol 148, 1429–1436 (2022). https://doi.org/10.1007/s00432-021-03726-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-021-03726-z