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Quantifying the interfractional displacement of the gastroesophageal junction during radiation therapy for esophageal cancer.

ABSTRACT: Accounting for interfractional changes in tumor location improves the accuracy of radiation treatment delivery. The purpose of this study was to quantify the interfractional displacement of the gastroesophageal junction (GEJ) based on standard treatment setup in patients with esophageal cancer undergoing radiation therapy.Free-breathing four-dimensional computed tomography (4D-CT) datasets were acquired weekly from 22 patients during treatment for esophageal adenocarcinoma. Scans were registered to baseline (simulation) 4D-CT scans by using bony landmarks. The distance between the center of the GEJ contour on the simulation scan and the mean location of GEJ centers on subsequent scans was used to assess changes in GEJ location between fractions; displacement was also correlated with clinical and respiratory variables.The mean absolute random error was 1.69 mm (range, 0.11-4.11 mm) in the lateral direction, 1.87 mm (range, 0.51-4.09 mm) in the anterior-posterior (AP) direction, and 3.09 mm (range, 0.99-6.16 mm) in the superior-inferior (SI) direction. The mean absolute systemic GEJ displacement between fractions was 2.88 mm lateral (? 5 mm in 14%), mostly leftward; 2.90 mm (? 5 mm in 14%) AP, mostly anterior; and 6.77 mm (? 1 cm in 18%) SI, mostly inferior. Variations in tidal volume and diaphragmatic excursion during treatment correlated strongly with systematic SI GEJ displacement (r = 0.964, p < 0.0001; and r = 0.944, p < 0.0001, respectively) and moderately with systematic AP GEJ displacement (r = 0.678, p = 0.0005; r = 0.758, p < 0.0001, respectively). Systematic displacement in the inferior direction resulted in higher-than-intended doses (? 60 Gy) to the GEJ, with increased hot-spot to the adjacent stomach and lung base.We found large (>1-cm) interfractional displacements in the GEJ in the SI (especially inferior) direction that was not accounted for when skeletal alignment alone was used for patient positioning. Because systematic displacement in the SI direction had dosimetric impact and correlated with tidal volume, better accounting for depth of breathing is needed to reduce interfractional variability.

SUBMITTER: Wang J

PROVIDER: S-EPMC3923625 | biostudies-literature | 2012 Jun

REPOSITORIES: biostudies-literature

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Quantifying the interfractional displacement of the gastroesophageal junction during radiation therapy for esophageal cancer.

Wang Jingya J Lin Steven H SH Dong Lei L Balter Peter P Mohan Radhe R Komaki Ritsuko R Cox James D JD Starkschall George G

International journal of radiation oncology, biology, physics 20120321 2

<h4>Purpose</h4>Accounting for interfractional changes in tumor location improves the accuracy of radiation treatment delivery. The purpose of this study was to quantify the interfractional displacement of the gastroesophageal junction (GEJ) based on standard treatment setup in patients with esophageal cancer undergoing radiation therapy.<h4>Methods and materials</h4>Free-breathing four-dimensional computed tomography (4D-CT) datasets were acquired weekly from 22 patients during treatment for es ...[more]

PMID: 22440040

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Project description:BackgroundTo estimate the adjusted conditional overall survival (COS) in patients with esophageal cancer after receiving various treatment modalities via a national population-based database, and to investigate the possible time-dependent effects.Materials and methodsEligible patients diagnosed with esophageal cancer between 2000 and 2016 were identified from the Surveillance, Epidemiology, and End Results (SEER) registry. The Kaplan-Meier method was used to calculate conventional survival time. The inverse probability of treatment weighting method was used to estimate the adjusted COS in patients receiving different treatment modalities. Landmark analysis was employed to investigate the possible time-dependent effects of different treatment modalities in patients who had survived a certain period of time.ResultsA total of 25,232 patients were included in the final analysis. The conventional 5-year overall survival was 19.3%. The 5-year adjusted COS increased most for the first 3 years, and increased slightly afterwards. In patients with regional esophageal or gastroesophageal junction cancer, stage-specific analysis showed that surgery only and preoperative radiation therapy benefited most for patients with localized disease, preoperative radiation therapy plus surgery benefited regional, and preoperative radiation therapy plus surgery benefited distant disease, with the 5-year adjusted COS given patients had survived 3 years being 67.0% (95% CI 65.2%-68.7%), 59.9% (95% CI 58.3%-61.5%), 58.4% (95% CI 56.3%-60.5%), and 61.8% (95% CI 59.5%-64.1%), respectively. In time-dependent analysis, the benefits of surgery only in localized cases were prominent within 48 months after diagnosis. Preoperative radiation therapy showed long-lasting benefits in patients with regional disease. In patients with distant disease, all treatment modalities showed similar and short-term effects.ConclusionsThe adjusted COS in patients with esophageal cancer increased as time accrued after receiving various treatment modalities. The time-dependent effects in specific tumor stage provided a dynamic view on optimization of treatment strategies.

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Quantifying the interfractional displacement of the gastroesophageal junction during radiation therapy for esophageal cancer.

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Quantifying the interfractional displacement of the gastroesophageal junction during radiation therapy for esophageal cancer.

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