Esophageal cancerInterfractional variability of respiration-induced esophageal tumor motion quantified using fiducial markers and four-dimensional cone-beam computed tomography
Section snippets
Patients and markers
We included 24 esophageal cancer patients with implanted gold markers, who were also included in former studies [11], [12], [14]. Two different types of gold markers were implanted: a solid marker (Cook Medical, Limerick, Ireland; or in–house manufactured) and a flexible coil-shaped marker (Visicoil; IBA Dosimetry, Bartlett, TN, USA) [11]. For each patient, 2–5 markers were placed at the cranial and caudal border of the primary tumor and, preferably, in the center of the tumor. The details of
Results
For over 97% of the markers, the interfractional mean amplitude was <10.0 mm in all three directions. The average motion trajectory and its 95% confidence interval (CI) in the four regions of the esophagus illustrated in Supplementary Fig. A2 indicate a predominant respiration-induced tumor motion in the CC direction and in the distal esophagus and proximal stomach. For the three directions and four regions, Supplementary Fig. A3 illustrates the amplitudes for individual markers and Table 2
Discussion
This is the first study that applied retrospectively reconstructed 4D-CBCT with implanted gold markers to investigate the interfractional variability of the respiration-induced esophageal tumor motion. The mean interfractional variability of amplitudes and trajectory shapes was found to be ≤1.4 mm and the mean deviation between the amplitudes measured in the 4D-CT and in the 4D-CBCT was ≤1.0 mm. These findings suggest that the amplitudes and trajectory shapes of the respiration-induced esophageal
Conflicts of interest
Dr. T. Alderliesten and Dr. A. Bel are both involved in projects supported by Elekta. Elekta had no involvement in the study design, the data collection, analysis and interpretation, and the writing of the manuscript.
Acknowledgments
The authors thank Elekta for the financial support of this work and thank Mr. C.M. van Leeuwen (Department of Radiation Oncology, Academic Medical Center, the Netherlands) for advices on statistical analysis.
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