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Considerable pancreatic tumor motion during breath-holding
Eelco Lens1, Astrid van der Horst1, Eva Versteijne1
1a Department of Radiation Oncology , Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands.
Acta Oncologica (Stockholm, Sweden)
|September 2, 2016
Summary
Pancreatic tumors move significantly during inhale breath-holds (BH) and vary between holds. Diaphragm motion does not reliably predict tumor movement during BH for radiotherapy planning.
Area of Science:
- Radiation Oncology
- Medical Imaging
- Gastrointestinal Oncology
Background:
- Breath-holding (BH) is utilized in radiotherapy to minimize abdominal organ motion.
- Tumor motion during inhale BH in pancreatic cancer patients remains under-investigated.
Purpose of the Study:
- Quantify pancreatic tumor motion during inhale BH.
- Assess tumor position variations between consecutive inhale BHs.
Main Methods:
- Twelve patients with intratumoral fiducials underwent three 30-second inhale BHs over three days.
- 2D image correlation tracked fiducials and diaphragm motion during BH.
- Tumor position variation between BHs was calculated from initial positions.
Main Results:
- Mean absolute maximum tumor motion was 4.2 mm (IS) and 2.7 mm (AP) during BH.
- Tumor and diaphragm motion showed only moderate correlation (Pearson's |r|>0.6 in 45/76 BHs).
- Mean tumor position variation between BHs was 0.2 mm (inferior) and 0.5 mm (anterior).
Conclusions:
- Substantial pancreatic tumor motion occurs during BH.
- Considerable inter-BH position variations exist, impacting treatment accuracy.
- The diaphragm is not a reliable surrogate for pancreatic tumor motion during BH.
