title: Spatial and volumetric changes of retroperitoneal sarcomas during pre-operative radiotherapy.
abstract: OBJECTIVE
  To determine the positional and volumetric changes of retroperitoneal sarcomas (RPS) during pre-operative external beam radiotherapy (PreRT).
  
  
  METHODS
  After excluding 2 patients who received chemotherapy prior to PreRT and 15 RPS that were larger than the field-of-view of cone-beam CT (CBCT), the positional and volumetric changes of RPS throughout PreRT were characterized in 19 patients treated with IMRT using CBCT image guidance. Analysis was performed on 118 CBCT images representing one image per week of those acquired daily during treatment. Intra-fraction breathing motions of the gross tumor volume (GTV) and kidneys were measured in 22 RPS patients simulated using 4D-CT. Fifteen other patients were excluded whose tumors were incompletely imaged on CBCT or who received pre-RT chemotherapy.
  
  
  RESULTS
  A GTV volumetric increase (mean: 6.6%, p=0.035) during the first 2 weeks (CBCT1 vs. CBCT2) of treatment was followed by GTV volumetric decrease (mean: 4%, p=0.009) by completion of radiotherapy (CBCT1 vs. CBCT6). Internal margins of 8.6, 15 and 15 mm in the lateral, anterior/posterior and superior/inferior directions would be required to account for inter-fraction displacements. The extent of GTV respiratory motion was significantly (p<0.0001) correlated with more superiorly positioned tumors.
  
  
  CONCLUSIONS
  Inter-fraction CBCT provides important volumetric and positional information of RPS which may improve PreRT quality and prompt re-planning. Planning target volume may be reduced using online soft-tissue matching to account for interfractional displacements of GTVs. Important breathing motion occurred in superiorly placed RPS supporting the utility of 4D-CT planning.
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Philip
authors.initials: P
authors.lastname: Wong
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Colleen
authors.initials: C
authors.lastname: Dickie
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Lee
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Chung
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Letourneau
authors.affiliation: Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Canada.
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Surgical Oncology, Mount Sinai and Princess Margaret Cancer Centre, University of Toronto, Canada.
authors.forename: Carol
authors.initials: C
authors.lastname: Swallow
authors.affiliation: Department of Surgical Oncology, Mount Sinai and Princess Margaret Cancer Centre, University of Toronto, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gladdy
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada. Electronic address: Charles.catton@rmp.uhn.on.ca.
authors.forename: Charles
authors.initials: C
authors.lastname: Catton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D054893:Cone-Beam Computed Tomography; D005260:Female; D056973:Four-Dimensional Computed Tomography; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D012186:Retroperitoneal Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D012509:Sarcoma / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery
keywords: Displacement; Pre-operative; Radiotherapy; Retroperitoneal; Sarcoma; Volume