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Comparison of internal target volumes defined on 3-dimensional, 4-dimensonal, and cone-beam CT images of non-small-cell lung cancer

Authors Li F, Li J, Ma Z, Zhang Y, Xing J, Qi H, Shang D

Received 23 April 2016

Accepted for publication 20 September 2016

Published 17 November 2016 Volume 2016:9 Pages 6945—6951


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Min Li

Fengxiang Li,1 Jianbin Li,1 Zhifang Ma,1 Yingjie Zhang,1 Jun Xing,1 Huanpeng Qi,1 Dongping Shang2

1Department of Radiation Oncology, 2Department of Big Bore CT Room, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of China

Purpose: The purpose of this study was to compare the positional and volumetric differences of internal target volumes defined on three-dimensional computed tomography (3DCT), four-dimensional CT (4DCT), and cone-beam CT (CBCT) images of non-small-cell lung cancer (NSCLC).
Materials and methods: Thirty-one patients with NSCLC sequentially underwent 3DCT and 4DCT simulation scans of the thorax during free breathing. The first CBCT was performed and registered to the planning CT using the bony anatomy registration during radiotherapy. The gross tumor volumes were contoured on the basis of 3DCT, maximum intensity projection (MIP) of 4DCT, and CBCT. CTV3D (clinical target volume), internal target volumes, ITVMIP and ITVCBCT, were defined with a 7 mm margin accounting for microscopic disease. ITV10 mm and ITV5 mm were defined on the basis of CTV3D: ITV10 mm with a 5 mm margin in left–right (LR), anterior–posterior (AP) directions and 10 mm in cranial–caudal (CC) direction; ITV5 mm with an isotropic internal margin (IM) of 5 mm. The differences in the position, size, Dice’s similarity coefficient (DSC) and inclusion relation of different volumes were evaluated.
Results: The median size ratios of ITV10 mm, ITV5 mm, and ITVMIP to ITVCBCT were 2.33, 1.88, and 1.03, respectively, for tumors in the upper lobe and 2.13, 1.76, and 1.1, respectively, for tumors in the middle-lower lobe. The median DSCs of ITV10 mm, ITV5 mm, ITVMIP, and ITVCBCT were 0.6, 0.66, and 0.83 for all patients. The median percentages of ITVCBCT not included in ITV10 mm, ITV5 mm, and ITVMIP were 0.1%, 1.63%, and 15.21%, respectively, while the median percentages of ITV10 mm, ITV5 mm, and ITVMIP not included in ITVCBCT were 57.08%, 48.89%, and 20.04%, respectively.
Conclusion: The use of the individual ITV derived from 4DCT merely based on bony registration in radiotherapy may result in a target miss. The ITVs derived from 3DCT with isotropic margins have a good coverage of the ITV from CBCT, but the use of those would result in a high proportion of normal tissue being irradiated unnecessarily.

Keywords: non-small-cell lung cancer, cone-beam CT, four-dimensional CT, three-dimensional CT, internal target volume, volume comparison

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