Diaphragm-based position verification to improve daily target dose coverage in proton and photon radiation therapy treatment of distal esophageal cancer
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Authors
Visser, Sabine
den Otter, Lydia A.
Ribeiro, Cássia O.
Korevaar, Erik W.
Both, Stefan
Langendijk, Johannes A.
Muijs, Christina T.
Sijtsema, Nanna M.
Author (Corporation)
Publication date
01.02.2022
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Course of study
Type
01A - Journal article
Editors
Editor (Corporation)
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Parent work
International Journal of Radiation. Oncology - Biology – Physics
Special issue
DOI of the original publication
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Series
Series number
Volume
112
Issue / Number
2
Pages / Duration
463-474
Patent number
Publisher / Publishing institution
Elsevier
Place of publication / Event location
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Practice partner / Client
Abstract
Purpose
In modern conformal radiation therapy of distal esophageal cancer, target coverage can be affected by variations in the diaphragm position. We investigated if daily position verification (PV) extended by a diaphragm position correction would optimize target dose coverage for esophageal cancer treatment.
Methods and Materials
For 15 esophageal cancer patients, intensity modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) plans were computed. Displacements of the target volume were correlated with diaphragm displacements using repeated 4-dimensional computed tomography images to determine the correction needed to account for diaphragm variations. Afterwards, target coverage was evaluated for 3 PV approaches based on: (1) bony anatomy (PV_B), (2) bony anatomy corrected for the diaphragm position (PV_BD) and (3) target volume (PV_T).
Results
The cranial-caudal mean target displacement was congruent with almost half of the diaphragm displacement (y = 0.459x), which was used for the diaphragm correction in PV_BD. Target dose coverage using PV_B was adequate for most patients with diaphragm displacements up till 10 mm (≥94% of the dose in 98% of the volume [D98%]). For larger displacements, the target coverage was better maintained by PV_T and PV_BD. Overall, PV_BD accounted best for target displacements, especially in combination with tissue density variations (D98%: IMPT 94% ± 5%, VMAT 96% ± 5%). Diaphragm displacements of more than 10 mm were observed in 22% of the cases.
Conclusions
PV_B was sufficient to achieve adequate target dose coverage in case of small deviations in diaphragm position. However, large deviations of the diaphragm were best mitigated by PV_BD. To detect the cases where target dose coverage could be compromised due to diaphragm position variations, we recommend monitoring of the diaphragm position before treatment through online imaging.
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ISBN
ISSN
0360-3016
1879-355X
1879-355X
Language
English
Created during FHNW affiliation
No
Strategic action fields FHNW
Publication status
Published
Review
Peer review of the complete publication
Open access category
Closed
License
Citation
Visser, S., den Otter, L. A., Ribeiro, C. O., Korevaar, E. W., Both, S., Langendijk, J. A., Muijs, C. T., Sijtsema, N. M., & Knopf, A. (2022). Diaphragm-based position verification to improve daily target dose coverage in proton and photon radiation therapy treatment of distal esophageal cancer. International Journal of Radiation. Oncology - Biology – Physics, 112(2), 463–474. https://doi.org/10.1016/j.ijrobp.2021.09.015