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4D-Listmode-PET-CT and 4D-CT for optimizing PTV margins in gastric lymphoma

Determination of intra- and interfractional gastric motion

4D-Listmode-PET-CT und 4D-CT für die Optimierung des PTV-Sicherheitsabstandes bei Magenlymphomen

Erfassung der intra- und interfraktionellen Magenbewegung

Strahlentherapie und Onkologie volume 192, pages 322–332 (2016)Cite this article

Abstract

Purpose

New imaging protocols for radiotherapy in localized gastric lymphoma were evaluated to optimize planning target volume (PTV) margin and determine intra-/interfractional variation of the stomach.

Methods

Imaging of 6 patients was explored prospectively. Intensity-modulated radiotherapy (IMRT) planning was based on 4D/3D imaging of computed tomography (CT) and positron-emission tomography (PET)-CT. Static and motion gross tumor volume (sGTV and mGTV, respectively) were distinguished by defining GTV (empty stomach), clinical target volume (CTV = GTV + 5 mm margin), PTV (GTV + 10/15/20/25 mm margins)  plus paraaortic lymph nodes and proximal duodenum. Overlap of 4D-Listmode-PET-based mCTV with 3D-CT-based PTV (increasing margins) and V95/D95 of mCTV were evaluated. Gastric shifts were determined using online cone-beam CT. Dose contribution to organs at risk was assessed.

Results

The 4D data demonstrate considerable intra-/interfractional variation of the stomach, especially along the vertical axis. Conventional 3D-CT planning utilizing advancing PTV margins of 10/15/20/25 mm resulted in rising dose coverage of mCTV (4D-Listmode-PET-Summation-CT) and rising D95 and V95 of mCTV. A PTV margin of 15 mm was adequate in 3 of 6 patients, a PTV margin of 20 mm was adequate in 4 of 6 patients, and a PTV margin of 25 mm was adequate in 5 of 6 patients.

Conclusion

IMRT planning based on 4D-PET-CT/4D-CT together with online cone-beam CT is advisable to individualize the PTV margin and optimize target coverage in gastric lymphoma.

Zusammenfassung

Hintergrund

Zur Optimierung des Sicherheitsabstandes beim Planungszielvolumen (PTV) und zur Erfassung der intra-/interfraktionellen Variation des Magens wurden neue Protokolle für die Bildverarbeitung in der Radiotherapie lokalisierter Magenlymphome evaluiert.

Methode

Die Bildgebung von 6 Patienten wurde prospektiv untersucht. Die Planung der intensitätsmodulierten Strahlentherapie (IMRT) basierte auf 4D-/3D-Bildgebung von Computertomographie (CT) und Positronenemissionstomographie-CT (PET-CT). Wir differenzierten zwischen „static“ und „motion“ Gesamttumorvolumen (sGTV, mGTV) unter Definition von GTV (leerer Magen), klinischem Zielvolumen (CTV= GTV + 5 mm Sicherheitsabstand), PTV (GTV + 10/15/20/25 mm Sicherheitsabstand)  plus  paraaortalen Lymphknoten (LK ) und  proximalem Duodenum. Die Überschneidung des 4D-Listmode-PET-basierten mCTV mit dem 3D-CT-basierten PTV (steigender Sicherheitssaum) und die V95/D95 des mCTV wurden evaluiert. Magenverschiebungen wurden im Online-Conebeam-CT bestimmt. Die Dosisverteilung für die Risikoorgane wurde berechnet.

Ergebnisse

Die 4D-Bilddaten zeigen die bemerkenswerte intra-/interfraktionelle Variation des Magens, insbesondere vertikal. Die konventionelle 3D-CT-Planung mit schrittweise zunehmenden PTV-Sicherheitsabständen von 10/15/20/25 mm resultierte in steigender Dosisversorgung des mCTV (4D-Listmode-PET-Summation-CT) und steigender D95 und V95 des mCTV. Bei 3 von 6 Patienten war ein PTV-Sicherheitsabstand von 15 mm ausreichend, bei 4 von 6 Patienten 20 mm und bei 5 von 6 Patienten 25 mm.

Schlussfolgerung

Die IMRT-Planung auf Basis von 4D-PET-CT/4D-CT mit der Online-Conebeam-CT kann die PTV-Sicherheitsabstände individualisieren und die Zielvolumenerfassung bei Magenlymphomen optimieren.

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Acknowledgments

This study was partly supported by the Deutsche Forschungsgemeinschaft (DFG), Collaborative Research Centre 656 (SFB 656), Muenster, Germany (projects B02 and B03).

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Affiliations

  1. Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer Campus 1, Gebäude 1A, 48419, Muenster, Germany

    Gabriele Reinartz M.D., Uwe Haverkamp Ph.D., Ramona Wullenkord, Philipp Lehrich, Jan Kriz M.D. & Hans Theodor Eich M.D.

  2. European Institute for Molecular Imaging (EIMI), University of Muenster, Muenster, Germany

    Florian Büther, Klaus Schäfers Ph.D. & Michael Schäfers M.D.

  3. Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany

    Michael Schäfers M.D.

  4. DFG EXC 1003, Cluster of Excellence ‘Cells in Motion’, Muenster, Germany

    Klaus Schäfers Ph.D. & Michael Schäfers M.D.

Authors
  1. Gabriele Reinartz M.D.
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  2. Uwe Haverkamp Ph.D.
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  3. Ramona Wullenkord
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  4. Philipp Lehrich
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  5. Jan Kriz M.D.
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  6. Florian Büther
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  7. Klaus Schäfers Ph.D.
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  8. Michael Schäfers M.D.
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  9. Hans Theodor Eich M.D.
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Corresponding author

Correspondence to Gabriele Reinartz M.D..

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Conflict of interest

G. Reinartz, U. Haverkamp, R. Wullenkord, P. Lehrich, J. Kriz, F. Büther, K. Schäfers, M. Schäfers, and H.T. Eich state that there are no conflicts of interest.

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Reinartz, G., Haverkamp, U., Wullenkord, R. et al. 4D-Listmode-PET-CT and 4D-CT for optimizing PTV margins in gastric lymphoma. Strahlenther Onkol 192, 322–332 (2016). https://doi.org/10.1007/s00066-016-0949-0

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  • DOI: https://doi.org/10.1007/s00066-016-0949-0

Keywords

  • Intensity-modulated radiotherapy
  • Positron-emission tomography
  • Gastric lymphoma
  • 4D computed tomography
  • Planning target volume margin
  • Cone-beam computed tomography

Schlüsselwörter

  • Intensitätsmodulierte Strahlentherapie
  • Positronenemissionstomographie
  • Magenlymphome
  • 4-D-Computertomographie
  • Sicherheitssaum Planungszielvolumen
  • Conebeam-Computertomographie