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Image-guided radiation therapy for carcinoma of gallbladder: implication on margin for set-up errors

Published online by Cambridge University Press:  28 May 2013

Gagan Saini ,
Vineeta Goel ,
Anil K Anand  and
Kamlesh Kumar Gupta
Gagan Saini*
Affiliation:
Department of Radiation Oncology, International Oncology Center, Fortis Hospital, Noida, India
Vineeta Goel
Affiliation:
Department of Radiation Oncology, Max Cancer Center, Max Super Specialty Hospital, New Delhi, India
Anil K Anand
Affiliation:
Department of Radiation Oncology, Max Cancer Center, Max Super Specialty Hospital, New Delhi, India
Kamlesh Kumar Gupta
Affiliation:
Department of Radiation Oncology, Max Cancer Center, Max Super Specialty Hospital, New Delhi, India
*
Correspondence to: Gagan SainiDepartment of Radiation Oncology, International Oncology Center, Fortis Hospital, Sector-62, Noida, India. Tel: 0120-4548512. E-mail: [email protected]
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Abstract

Purpose

A retrospective study was undertaken to analyse set-up variations in patients being treated with post-operative radiation therapy for carcinoma of gall bladder by image-guided radiotherapy (IGRT) using cone-beam computed tomography (CBCT) scans and paired kilovoltage beam portals (kVps).

Materials and methods

Three consecutive patients receiving post-operative radiation therapy for carcinoma of gall bladder were studied. A total of 32 imaging studies were performed. The immobilisation system was an all-in-one system along with a thermoplastic mask, with knees either resting on the knee rest or in a vacuum cushion. The CBCT scans and kVps were reviewed in an off-line mode. The surrogate markers used for matching during co-registration were 12th rib, coeliac trunk, vertebral bodies and canal. Individual readings were used to calculate mean shifts (m); the mean of these means (M) was calculated to arrive at the systematic error in each direction and its standard deviation (Σ) was calculated. The margins for set-up error (SM) were then calculated.

Results

There were a total of 32 readings of which 21 were CBCTs and 11 were kVps. The mean shifts in each direction for each patient were 0·06, 0·25 and 0·15 cm in vertical, longitudinal and lateral directions, respectively. The resultant planning target volume margins calculated were 0·24, 0·9 and 0·47 cm in vertical, longitudinal and lateral directions.

Conclusions

IGRT for upper abdominal malignancies using CBCT and kVps is a useful method to keep the margins for set-up error low. The use of surrogates for matching should be relevant to the target volume. Good immobilisation system helps in keeping the margins low.

Keywords

CBCTIGRTimmobilisationmatching techniques and surrogatesupper abdominal malignancies
Type
Short Communication
Information
Journal of Radiotherapy in Practice , Volume 12 , Issue 3 , September 2013 , pp. 263 - 271
Copyright
Copyright © Cambridge University Press 2013 

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References

1.Jemal, A, Siegel, R, Xu, J, Ward, E. Cancer statistics. CA Cancer J Clin 2010; 60 (5): 277–300.CrossRefGoogle Scholar
2.Randi, G, Franceschi, S, La Vecchia, C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer 2006; 118 (7): 1591–1602.CrossRefGoogle ScholarPubMed
3.Lowenfels, A B, Maisonneuve, P, Boyle, P, Zatonski, W A. Epidemiology of gallbladder cancer. Hepatogastroenterology 1999; 46: 1529–1532.Google ScholarPubMed
4. Kapoor V K, McMichael A J. Gallbladder cancer: an ‘Indian’ disease. Natl Med J India 2003; 16 (4): 209–213.Google Scholar
5.http://icmr.nic.in/ncrp/report_pop_2001-04/Chapter%2001-05%20Pages%201%20to%2053.pdf. Accessed 11th February 2012.Google Scholar
6.Mahe, M, Stampfli, C, Romestaing, P, Salerno, N, Gerard, J P. Primary carcinoma of the gall-bladder: potential for external radiation therapy. Radiother Oncol 1994; 33: 204–208.CrossRefGoogle ScholarPubMed
7.Kresl, J J, Schild, S E, Henning, G Tet al. Adjuvant external beam radiation therapy with concurrent chemotherapy in the management of gallbladder carcinoma. Int J Radiat Oncol Biol Phys 2002; 52: 167–175.CrossRefGoogle ScholarPubMed
8.Donohue, J H, Nagorney, D M, Grant, C S, Tsushima, K, Ilstrup, D M, Adson, M A. Carcinoma of the gallbladder. Does radical resection improve outcome? Arch Surg 1990; 125: 237–241.CrossRefGoogle ScholarPubMed
9.Shirai, Y, Yoshida, K, Tsukada, K, Muto, T. Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy. Ann Surg 1992; 215: 326–331.CrossRefGoogle ScholarPubMed
10.Wanebo, H, Castle, W N, Fechner, R E. Is carcinoma of the gallbladder a curable lesion? Ann Surg 1982; 195: 624–631.CrossRefGoogle ScholarPubMed
11.Nakamura, S, Sakaguchi, S, Suzuki, S, Muro, H. Aggressive surgery for carcinoma of the gallbladder. Surgery 1989; 106: 467–473.Google ScholarPubMed
12.Chijiiwa, K, Sumiyoshi, K, Nakayama, F. Impact of recent advances in hepatobiliary imaging techniques on the preoperative diagnosis of carcinoma of the gallbladder. World J Surg 1991; 15: 322–327.CrossRefGoogle ScholarPubMed
13.Cubertafond, P, Gainant, A, Cucchiaro, G. Surgical treatment of 724 carcinomas of the gallbladder. Results of the French Surgical Association Survey. Ann Surg 1994; 219: 275–280.CrossRefGoogle ScholarPubMed
14.Ruckert, J C, Ruckert, R I, Gellert, K, Hecker, K, Müller, J M. Surgery for carcinoma of the gallbladder. Hepatogastroenterology 1996; 43: 527–533.Google ScholarPubMed
15.Arnaud, J P, Casa, C, Georgeac, Cet al. Primary carcinoma of the gallbladder: review of 143 cases. Hepatogastroenterology 1995; 42: 811–815.Google ScholarPubMed
16.Houry, S, Schlienger, M, Huguier, M, Lacaine, F, Penne, F, Laugier, A. Gallbladder carcinoma: role of radiation therapy. Br J Surg 1989; 76: 448–450.CrossRefGoogle ScholarPubMed
17.Hanna, S S, Rider, W D. Carcinoma of the gallbladder or extrahepatic bile ducts: the role of radiotherapy. Can Med Assoc J 1978; 118: 59–61.Google ScholarPubMed
18.Fields, J, Emami, B. Carcinoma of the extrahepatic biliary system—results of primary and adjuvant radiotherapy. Int J Radiat Oncol Biol Phys 1987; 13: 331–338.CrossRefGoogle ScholarPubMed
19.Treadwell, T A, Hardin, W J. Primary carcinoma of the gallbladder. The role of adjunctive therapy in its treatment. Am J Surg 1976; 132: 703–706.CrossRefGoogle ScholarPubMed
20.Smoron, G L. Radiation therapy of carcinoma of gallbladder and biliary tract. Cancer 1977; 40: 1422–1424.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
21.Pilepich, M V, Lambert, P M. Radiotherapy of carcinomas of the extrahepatic biliary system. Radiology 1978; 127: 767–770.CrossRefGoogle ScholarPubMed
22.Kopelson, G, Gunderson, L L. Primary and adjuvant radiation therapy in gallbladder and extrahepatic biliary tract carcinoma. J Clin Gastroenterol 1983; 5: 43–50.CrossRefGoogle ScholarPubMed
23.Kim, S, Kim, S W, Bang, Y J, Heo, D S, Ha, S W. Role of postoperative radiotherapy in the management of extrahepatic bile duct cancer. Int J Radiat Oncol Biol Phys 2002; 54: 414–419.CrossRefGoogle ScholarPubMed
24.Halperin, E C, Perez, C A, Brady, L W (eds). Liver and hepatobiliary tract (Chapter 57). In: Perez and Brady's Principles and Practice of Radiation Oncology, 5th edition. Philadelphia, USA: Lippincott Williams and Wilkins, 2008: 1349–1366.Google Scholar
25.Czito, B G, Hurwitz, H I, Clough, R W, Tyler, D S, Morse, M A, Clary, B M. Adjuvant external-beam radiotherapy with concurrent chemotherapy after resection of primary gallbladder carcinoma: a 23-year experience. Int J Radiat Oncol Biol Phys 2005; 62: 1030–1034.CrossRefGoogle ScholarPubMed
26.Wieland, P, Dobler, B, Mai, Set al. IMRT for postoperative treatment of gastric cancer: covering large target volumes in the upper abdomen: a comparison of a step-and-shoot and an arc therapy approach. Int J Radiat Oncol Biol Phys 2004; 59: 1236–1244.CrossRefGoogle Scholar
27.Fuller, C D, Thomas, C R Jr, Wong, Aet al. Image-guided intensity-modulated radiation therapy for gallbladder carcinoma. Radiother Oncol 2006; 81: 65–72.CrossRefGoogle ScholarPubMed
28.Ringash, J, Perkins, G, Brierley, Jet al. IMRT for adjuvant radiation in gastric cancer: a preferred plan? Int J Radiat Oncol Biol Phys 2005; 63: 732–738.CrossRefGoogle ScholarPubMed
29.Ben-Josef, E, Shields, A F, Vaishampayan, Uet al. Intensity-modulated radiotherapy (IMRT) and concurrent capecitabine for pancreatic cancer. Int J Radiat Oncol Biol Phys 2004; 59: 454–459.CrossRefGoogle ScholarPubMed
30.Fuss, M, Salter, B J, Cavanaugh, S Xet al. Daily ultrasound-based image-guided targeting for radiotherapy of upper abdominal malignancies. Int J Radiat Oncol Biol Phys 2004; 59: 1245–1256.CrossRefGoogle ScholarPubMed
31.Boda-Heggemann, J, Mennemeyer, P, Wertz, Het al. Accuracy of ultrasound-based image guidance for daily positioning of the upperabdomen: an online comparison with cone beam CT. Int J Radiat Oncol Biol Phys 2009 ; 74: 892–897.CrossRefGoogle Scholar
32.Perkins, C L, Fox, T, Elder, E, Kooby, D A, Staley, C A III, Landry, J. Image-guided radiation therapy (IGRT) in gastrointestinal tumors. JOP 2006; 7: 372–381.Google ScholarPubMed
33.Van Herk, M. Errors and margins in radiotherapy. Semin Radiat Oncol 2004; 14: 52–64.CrossRefGoogle ScholarPubMed
34.Stroom, J C, de Boer, H C, Huizenga, H, Visser, A G. Inclusion of geometrical uncertainties in radiotherapy treatment planning by means of coverage probability. Int J Radiat Oncol Biol Phys 1999; 43: 905–919.CrossRefGoogle ScholarPubMed
35.Halperin, E C, Perez, C A, Brady, L W (eds). Biological basis of radiation therapy (Chapter 2). In: Perez and Brady's Principles and Practice of Radiation Oncology. Philadelphia, USA: Lippincott Williams and Wilkins, 2008: 76–109Google Scholar
36.http://www.nccn.org/professionals/physician_gls/PDF/gastric.pdf. Accessed on 11th February 2012.Google Scholar
37.http://www.nccn.org/professionals/physician_gls/PDF/hepatobiliary.pdf. Accessed on 11th February 2012.Google Scholar
38.Gold, D G, Miller, R C, Haddock, M Get al. Adjuvant therapy for gallbladder carcinoma: the Mayo Clinic Experience. Int J Radiat Oncol Biol Phys 2009; 75: 150–155.CrossRefGoogle ScholarPubMed
39.Czito, B G, Anscher, M S, Willett, C G. Radiation therapy in the treatment of cholangiocarcinoma. Oncology (Williston Park) 2006; 20: 873–884; discussion 886–888, 893–895.Google ScholarPubMed