Real-time tumor-tracking radiotherapy with SyncTraX for primary liver tumors requiring isocenter shift

Author:

Uchinami Yusuke1,Miyamoto Naoki23,Abo Daisuke4,Morita Ryo4,Ogawa Koji5,Kakisaka Tatsuhiko6,Suzuki Ryusuke2,Miyazaki Tomohiko7,Taguchi Hiroshi7,Katoh Norio1,Aoyama Hidefumi1

Affiliation:

1. Hokkaido University Faculty of Medicine and Graduate School of Medicine Department of Radiation Oncology, , North 15 West 7, Kita-ku, Sapporo 060-8638, Japan

2. Hokkaido University Hospital Department of Medical Physics, , North 14 West 5, Kita-ku, Sapporo 060-8648, Japan

3. Hokkaido University Faculty of Engineering Division of Applied Quantum Science and Engineering, , North 13 West 8, Kita-ku, Sapporo 060-8628, Japan

4. Hokkaido University Hospital Department of Diagnostic and Interventional Radiology, , North 14 West 5, Kita-ku, Sapporo 060-8648, Japan

5. Hokkaido University Faculty of Medicine Department of Gastroenterology and Hepatology, , North 15 West 7, Kita-ku, Sapporo 060-8638, Japan

6. Hokkaido University Faculty of Medicine Department of Gastroenterological Surgery, , North 15 West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan

7. Hokkaido University Hospital Department of Radiation Oncology, , North 14 West 5, Kita-ku, Sapporo 060-8648, Japan

Abstract

Abstract The SyncTraX series enables real-time tumor-tracking radiotherapy through the real-time recognition of a fiducial marker using fluoroscopic images. In this system, the isocenter should be located within approximately 5–7.5 cm from the marker, depending on the version, owing to the limited field of view. If the marker is placed away from the tumor, the isocenter should be shifted toward the marker. This study aimed to investigate stereotactic body radiotherapy (SBRT) outcomes of primary liver tumors treated with SyncTraX in cases where the isocenter was shifted marginally or outside the planning target volume (PTV). Twelve patients with 13 liver tumors were included in the analysis. Their isocenter was shifted toward the marker and was placed marginally or outside the PTV. The prescribed doses were generally 40 Gy in four fractions or 48 Gy in eight fractions. The overall survival (OS) and local control (LC) rates were calculated using the Kaplan–Meier method. All patients completed the scheduled SBRT. The median distance between the fiducial marker and PTV centroid was 56.0 (interquartile range [IQR]: 52.7–66.7) mm. By shifting the isocenter toward the marker, the median distance between the marker and isocenter decreased to 34.0 (IQR: 33.4–39.7) mm. With a median follow-up period of 25.3 (range: 6.9–70.0) months, the 2-year OS and LC rates were 100.0% (95% confidence interval: 100–100). An isocenter shift makes SBRT with SyncTraX feasible in cases where the fiducial marker is distant from the tumor.

Funder

Japan Society for the Promotion of Science KAKENHI

Grant-in-Aid for Research on Radiation Oncology

Publisher

Oxford University Press (OUP)

Subject

Health, Toxicology and Mutagenesis,Radiology, Nuclear Medicine and imaging,Radiation

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