Comparative Study Between Respiratory Gated Conventional 2-D Plan and 3-D Conformal Plan for Predicting Radiation Hepatitis

Lee, Sang wook; Kim, Gwi Eon; Chung, Kap Soo; Lee, Chang Geol; Seong, Jinsil; Suh, Chang Ok

Abstract

PURPOSE: To evaluate influences associated with radiation treatment planning obtained with the patient breathing freely. MATERIAL AND METHODS: We compared reduction or elimination of planning target volume (PTV) margins with 2-D conventional plan with inclusion of PTV margins associated with breathing with 3-D conformal therapy. The respiratory non gated 3-D conformal treatment plans were compared with respiratory gated conventional 2-D plans in 4 patients with hepatocellular carcinomas. Isodose distribution, dose statistics, and dose volume histogram (DVH) of PTVs were used to evaluate differences between respiratory gated conventional 2-D plans and respiratory non gated 3-D conformal treatment plans. In addition, the risk of radiation exposure of surrounding normal liver and organs are evaluated by means of DVH and normal tissue complication probabilities (NTCPs).
RESULTS
The vertical movement of liver ranged 2-3 cm in all patients. We found no difference between respiratory gated 2-D plans and 3-D conformal treatment plans with the patients breathing freely. Treatment planning using DVH analysis of PTV and the normal liver was used for all patients. DVH and calculated NTCP showed no difference in respiratory gated 2-D plans and respiratory non gated 3-D conformal treatment plans.
CONCLUSION
Respiratory gated radiation therapy was very important in hepatic tumors because radiation induced hepatitis was dependent on remaining normal liver volume. Further investigational studies for respiratory gated radiation treatment combined with 3-D conformal treatment are required.