A comparison of two immobilization systems for stereotactic body radiation therapy of lung tumors

doi:10.1016/j.radonc.2010.01.025

Radiotherapy and Oncology

Volume 95, Issue 1, April 2010, Pages 103-108

https://doi.org/10.1016/j.radonc.2010.01.025 Get rights and content

Abstract

Purpose

This study aims to compare the efficacy, efficiency and comfort level of two immobilization systems commonly used in lung stereotactic body radiation therapy (SBRT): the Bodyfix and the abdominal compression plate (ACP).

Materials and methods

Twenty-four patients undergoing SBRT for medically inoperable stage I lung cancer or pulmonary metastases were entered on this prospective randomized study. All underwent 4DCT simulation with free breathing, the Bodyfix, and the ACP to assess respiratory tumor motion. After CT simulation, patients were randomly assigned to immobilization with either the Bodyfix or the ACP for the actual SBRT treatment. Cone beam CTs (CBCTs) were acquired before and after each treatment to assess intrafraction tumor motion. Setup time and patient comfort were recorded.

Results

There were 16 upper lobe, two middle lobe and seven lower-lobe lesions. Both the Bodyfix and the ACP significantly reduced the superior–inferior (SI) and overall respiratory tumor motion compared to free breathing (4.6 and 4.0 vs 5.3 mm; 5.3 and 4.7 vs 6.1 mm, respectively, p < 0.05). The ACP further reduced the SI and overall respiratory tumor motion compared to the Bodyfix (p < 0.05). The mean overall intrafraction tumor motion was 2.3 mm with the Bodyfix and 2.0 mm with the ACP (p > 0.05). The ACP was faster to set up and rated more comfortable by patients than the Bodyfix (p < 0.05).

Conclusions

While there is no significant difference between the Bodyfix and ACP in reducing intrafraction tumor motion, the ACP is more comfortable, faster to set up, and superior to the Bodyfix in reducing SI and overall respiratory tumor motion.

Section snippets

Patient eligibility

Ethical approval for this study was obtained from the research ethics board of Sunnybrook Health Sciences Center. Between October 2008 and July 2009, 24 consecutive patients undergoing lung SBRT at Sunnybrook Health Sciences Center were prospectively entered into the study. Patients were eligible for the study if they had stage I NSCLC or lung oligometastases suitable for SBRT with curative intent, and were medically inoperable or refused surgery. The maximum tumor diameter had to be ⩽5 cm.

Patient and tumor characteristics

Twenty-four patients with stage I NSCLC or oligometastases in the lung were enrolled onto the study. Median age was 75 (range 54–89). There were 13 male and 11 female patients. Twenty patients had medically inoperable disease due to poor lung function and/or co-morbidities and four refused surgery. One patient had two lung lesions. The distribution of tumor location was: three left upper lobe, two left lower lobe, 13 right upper lobe, two right middle lobe and five right lower lobe (Fig. 2).

Discussion

This study is the first to compare the efficacy (reducing respiratory and intrafraction tumor motion), efficiency (setup time) and comfort level of two SBRT immobilization systems: the Bodyfix and the ACP. Our findings indicate that the ACP is superior to the Bodyfix in reducing SI and overall respiratory tumor motion, faster to set up, and more comfortable than the Bodyfix. There is no significant difference between the Bodyfix and ACP in reducing intrafraction tumor motion.

Free breathing

Conclusion

Although there is no significant difference between the Bodyfix and ACP in reducing intrafraction tumor motion, the ACP is superior to the Bodyfix in terms of its efficacy in reducing SI and overall respiratory tumor motion, efficiency and comfort level. As such, the ACP may be the preferred method of immobilization for patients undergoing SBRT for lung tumors.

Conflict of interest statement

The authors declare that conflicts of interest do not exist.

Acknowledgements

We thank patients who participated in this study, and Darby Erler, Ada Wong, Naila Devji, Derek Hyde and radiation therapists at Sunnybrook Health Sciences Center for their assistance.

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Citation Excerpt :
Han et al’s study of 24 patients compared 2 different abdominal compression systems (the BodyFIX vs the abdominal compression plate) in a prospective randomized study of efficacy, efficiency, and comfort during lung SBRT for early-stage lung cancer or oligometastases. Although there was no significant difference between the 2 immobilization systems in reducing intrafraction tumor motion, the compression plate was noted to be more comfortable, faster to set up, and superior in reducing overall tumor motion.13 In looking at the impact of pulmonary function, body habitus, and SBRT immobilization on setup and reproducibility for upper lung tumors, Sio et al14 compared their 2 immobilization strategies: full-length BodyFIX for 76 lesions to thermoplastic S-frame for 17 lesions, and showed that local control was excellent at 2 years, with no significant difference between the 2 systems.14
Abdominal compression (COMP) and breath-hold with an active breathing coordinator (ABC) device are 2 different respiratory motion management techniques used in lung stereotactic body radiation therapy (SBRT) practice. We compared local failure (LF) results for COMP versus ABC.
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From October 2003 to July 2014, 873 patients with 931 lesions were treated. Patient characteristics included: 455 (52.1%) female; median age of 73 years (range, 37-97); median Karnofsky performance status (KPS) of 80 (range, 40-100); and median BMI of 26.2 (range, 12.1-56.3). Tumor characteristics included: median tumor size of 2.2 cm (range, 0.7-10.0); median maximum standardized uptake value from positron emission tomography PET SUVmax of 7.5 (range, 0.8-59); 234 (25.4%) were central lesions; 830 (89.2%) lesions were PRIME; and 101 (10.8%) were OLIGO. Median follow-up and SBRT dose were 16.4 months and 50 G in 5 fractions, respectively. Overall crude rate of LF was 9.9%. Use of ABC was not associated with increased LF compared with COMP: hazard ratio (HR) = 1.043 (95% CI 0.48-2.29; P = .92). Three-year actuarial rates of LF for ABC versus COMP were 13.8% and 16.5%, respectively. After stratifying by OLIGO/PRIME, neither ABC nor COMP was significantly associated with LF. Central location may be associated with LF with ABC (HR = 2.087, P = .066). On univariate analysis, BMI, tumor size, PET SUV max and central location were associated with failure, with size the most significant.
LF rates after lung SBRT were not influenced by form of motion control overall or when stratified by tumor type. Further study on LF rates for central tumors where ABC is used is warranted.
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SBRT of lung tumorsA comparison of two immobilization systems for stereotactic body radiation therapy of lung tumors

Abstract

Purpose

Materials and methods

Results

Conclusions

Section snippets

Patient eligibility

Patient and tumor characteristics

Discussion

Conclusion

Conflict of interest statement

Acknowledgements

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Chest

Lung Cancer

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Radiother Oncol

Radiother Oncol

SBRT of lung tumors
A comparison of two immobilization systems for stereotactic body radiation therapy of lung tumors