Measurement of intra-fraction displacement of the mediastinal metastatic lymph nodes using four-dimensional CT in non-small cell lung cancer.
OBJECTIVE
To measure the intra-fraction displacements of the mediastinal metastatic lymph nodes by using four-dimensional CT (4D-CT) in non-small cell lung cancer (NSCLC).


METHODS
Twenty-four patients with NSCLC, who were to be treated by using three dimensional conformal radiation therapy (3D-CRT), underwent a 4D-CT simulation during free breathing. The mediastinal metastatic lymph nodes were delineated on the CT images of 10 phases of the breath cycle. The lymph nodes were grouped as the upper, middle and lower mediastinal groups depending on the mediastinal regions. The displacements of the center of the lymph node in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were measured.


RESULTS
The mean displacements of the center of the mediastinal lymph node in the LR, AP, and SI directions were 2.24 mm, 1.87 mm, and 3.28 mm, respectively. There were statistically significant differences between the displacements in the SI and LR, and the SI and AP directions (p < 0.05). For the middle and lower mediastinal lymph nodes, the displacement difference between the AP and SI was statistically significant (p = 0.005; p = 0.015), while there was no significant difference between the LR and AP directions (p < 0.05).


CONCLUSIONS
The metastatic mediastinal lymph node movements are different in the LR, AP, and SI directions in patients with NSCLC, particularly for the middle and lower mediastinal lymph nodes. The spatial non-uniform margins should be considered for the metastatic mediastinal lymph nodes in involved-field radiotherapy.
Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Jinan 250117, China.
Suzhen
S
Wang
Jianbin
J
Li
Yingjie
Y
Zhang
Wei
W
Wang
Fengxiang
F
Li
Tingyong
T
Fan
Min
M
Xu
Qian
Q
Shao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D003287:Contrast Media; D005260:Female; D056973:Four-Dimensional Computed Tomography / Q000379:methods*; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D018709:Statistics, Nonparametric
D003287:Contrast Media; C093233:iobitridol; D007472:Iohexol