Observation of different tumor motion magnitude within liver and estimate of internal motion margins in postoperative patients with hepatocellular carcinoma.

Abstract

To assess motion magnitude in different parts of the liver through surgical clips in postoperative patients with hepatocellular carcinoma and to examine the correlation between the clip and diaphragm motion.Four-dimensional computed tomography images from 30 liver cancer patients under thermoplastic mask immobilization were selected for this study. Three to seven surgical clips were placed in the resection cavity of each patient. The liver volume on computed tomography image was divided into the right upper (RU), right middle (RM), right lower (RL), hilar, and left lobes. Agreement between the clip and diaphragm motion was assessed by calculating intraclass correlation coefficient, and Bland-Altman analysis (Diff). Furthermore, population-based and patient-specific margins for internal motion were evaluated.The clips located in the RU lobe showed the largest motion, (7.5±1.6) mm, which was significantly more than in the RM lobe (5.7±2.8 mm, p=0.019), RL lobe (4.8±3.3 mm, p=0.017), and hilar lobe (4.7±2.7 mm, p<0.001) in the cranial-caudal direction. The mean intraclass correlation coefficient values between the clip and diaphragm motion were 0.915, 0.735, 0.678, 0.670, and the mean Diff values between them were 0.1±0.8 mm, 2.3±1.4 mm, 3.1±2.0 mm, 2.4±1.5 mm, when clips were located in the RU lobe, RM lobe, RL lobe, and hilar lobe, respectively. The clip and diaphragm motions had high concordance when clips were located in the RU lobe. Internal margin can be reduced from 5 mm in the cranial-caudal direction based on patient population average and to 3 mm based on patient-specific margins.The motion magnitude of clips varied significantly depending on their location within the liver. The diaphragm was a more appropriate surrogate for tumor located in the RU lobe than for other lobes.

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Published Version (Please cite this version)

10.2147/cmar.s147185

Publication Info

Zhao, Yu-Ting, Zhi-Kai Liu, Qiu-Wen Wu, Jian-Rong Dai, Tao Zhang, Angela Y Jia, Jing Jin, Shu-Lian Wang, et al. (2017). Observation of different tumor motion magnitude within liver and estimate of internal motion margins in postoperative patients with hepatocellular carcinoma. Cancer management and research, 9. pp. 839–848. 10.2147/cmar.s147185 Retrieved from https://hdl.handle.net/10161/21116.

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Wu

Qiuwen Wu

Professor of Radiation Oncology

My research interests include intensity-modulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT), Dynamic Electron Arc Radiotherapy (DEAR), and image-guided radiation therapy (IGRT). For IMRT, my work includes the development of the research platform, fast and accurate dose calculations, optimization based on physical and biological objectives such as generalized equivalent uniform dose (gEUD), and delivery with a dynamic multi-leaf collimator (DMLC). For VMAT, I am interested in optimization, quality assurance, and novel applications. For DEAR, I'm interested in the treatment planning and delivery verifications. For IGRT, my work includes the development of the infrastructure of the online and offline image guidance, characterization of patient anatomic changes and treatment uncertainties, margin calculations, and adaptive treatment planning. My recent research interests also include the use of AI in treatment planning, Brachytherapy dose calculation and plan optimization.

My clinical interests include prostate cancer, head and neck cancer, total body irradiation (TBI), and total skin irradiation (TSI)


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