title: Image-guided stereotactic body radiotherapy for lung tumors using BodyLoc with tomotherapy: clinical implementation and set-up accuracy.
abstract: We investigated the use of a BodyLoc immobilization and stereotactic localization device combined with TomoTherapy megavoltage CT (MVCT) in lung stereotactic body radiotherapy (SBRT) to reduce set-up uncertainty and treatment time. Eight patients treated with 3-5 fractions of SBRT were retrospectively analyzed. A BodyLoc localizer was used in both CT simulation for localization and the initial patient treatment set-up. Patients were immobilized with a vacuum cushion on the back and a thermoplastic body cast on the anterior body. Pretreatment MVCT from the TomoTherapy unit was fused with the planning kilovoltage CT (KVCT) before each fraction of treatment to determine interfractional set-up error. The comparison of two MVCTs during a fraction of treatment resulted in the intrafractional uncertainty of the treatment. A total of 224 target isocenter shifts were analyzed to assess these inter- and intrafractional tumor motions. We found that for interfractional shifts, the mean set-up errors and standard deviations were -1.1 +/- 2.8 mm, -2.5 +/- 8.7 mm, and 4.1 +/- 2.6 mm, for lateral, longitudinal, and vertical variation, respectively; the mean setup rotational variation was -0.3 +/- 0.7 degrees; and the maximum motion was 13.5 mm in the longitudinal direction. For intrafractional shifts, the mean set-up errors and standard deviations were -0.1 +/- 0.7 mm, -0.3 +/- 2.0 mm, and 0.5 +/- 1.1 mm for the lateral, longitudinal, and vertical shifts, respectively; the mean rotational variation was 0.1 +/- 0.2 degrees; and the maximum motion was 3.8 mm in the longitudinal direction. There was no correlation among patient characteristics, set-up uncertainties, and isocenter shifts, and the interfractional set-up uncertainties were larger than the intrafractional isocenter shift. The results of this study suggested that image-guided stereotactic body radiotherapy using the BodyLoc immobilization system with TomoTherapy can improve treatment accuracy.
authors.affiliation: Center for Cancer Treatment, Sharp Grossmont Hospital, La Mesa, CA, USA. jining.zhou@sharp.com
authors.forename: Jining
authors.initials: J
authors.lastname: Zhou
authors.forename: Barry
authors.initials: B
authors.lastname: Uhl
authors.forename: Kelly
authors.initials: K
authors.lastname: Dewitt
authors.forename: Mark
authors.initials: M
authors.lastname: Young
authors.forename: Brian
authors.initials: B
authors.lastname: Taylor
authors.forename: Ding-Yu
authors.initials: DY
authors.lastname: Fei
authors.forename: Yeh-Chi
authors.initials: YC
authors.lastname: Lo
mesh_terms: D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D007103:Immobilization / Q000295:instrumentation*; D008175:Lung Neoplasms / Q000601:surgery*; D016634:Radiosurgery / Q000295:instrumentation*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*