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Correlation of primary middle and distal esophageal cancers motion with surrounding tissues using four-dimensional computed tomography

Authors Wang W, Li J, Zhang Y, Shao Q, Xu M, Guo B, Shang D

Received 13 November 2015

Accepted for publication 3 April 2016

Published 22 June 2016 Volume 2016:9 Pages 3705—3710

DOI https://doi.org/10.2147/OTT.S100460

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Professor Jianmin Xu


Wei Wang,1 Jianbin Li,1 Yingjie Zhang,1 Qian Shao,1 Min Xu,1 Bing Guo,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: To investigate the correlation of gross tumor volume (GTV) motion with the structure of interest (SOI) motion and volume variation for middle and distal esophageal cancers using four-dimensional computed tomography (4DCT).
Patients and methods: Thirty-three patients with middle or distal esophageal carcinoma underwent 4DCT simulation scan during free breathing. All image sets were registered with 0% phase, and the GTV, apex of diaphragm, lung, and heart were delineated on each phase of the 4DCT data. The position of GTV and SOI was identified in all 4DCT phases, and the volume of lung and heart was also achieved. The phase relationship between the GTV and SOI was estimated through Pearson’s correlation test.
Results: The mean peak-to-peak displacement of all primary tumors in the lateral (LR), anteroposterior (AP), and superoinferior (SI) directions was 0.13 cm, 0.20 cm, and 0.30 cm, respectively. The SI peak-to-peak motion of the GTV was defined as the greatest magnitude of motion. The displacement of GTV correlated well with heart in three dimensions and significantly associated with bilateral lung in LR and SI directions. A significant correlation was found between the GTV and apex of the diaphragm in SI direction (rleft=0.918 and rright=0.928). A significant inverse correlation was found between GTV motion and varying lung volume, but the correlation was not significant with heart (rLR=–0.530, rAP=–0.531, and rSI=–0.588) during respiratory cycle.
Conclusion: For middle and distal esophageal cancers, GTV should expand asymmetric internal margins. The primary tumor motion has quite good correlation with diaphragm, heart, and lung.

Keywords: esophageal neoplasms, 4D-CT, gross tumor volume, displacement correlation

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