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The spine and carina as a surrogate for target registration in cone-beam CT imaging verification in locally advanced lung cancer radiotherapy

Jasna But-Hadzic
Jasna But-Hadzic
, 
Karmen Strljic
Karmen Strljic
 and 
Valerija Zager Marcius
Valerija Zager Marcius
   | Mar 22, 2023
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Article Category: Research Article
Published Online: Mar 22, 2023
Page range: 86 - 94
Received: May 08, 2022
Accepted: Oct 19, 2022
DOI: https://doi.org/10.2478/raon-2022-0048
© 2023 Jasna But-Hadzic, Karmen Strljic, Valerija Zager Marcius, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

Automatic clip box carina registration with manual alignment check. Target contours (gross tumour volume [GTV] inner contour, planning target volume [PTV] outer contour) are imported for target registration.
Automatic clip box carina registration with manual alignment check. Target contours (gross tumour volume [GTV] inner contour, planning target volume [PTV] outer contour) are imported for target registration.

Figure 2

Spine to target (A) and carina to target (B) registration set-up deviation in the lateral (LAT), longitudinal (LONG) and vertical (VRT) directions.
Spine to target (A) and carina to target (B) registration set-up deviation in the lateral (LAT), longitudinal (LONG) and vertical (VRT) directions.

Spine/target registration deviation according to tumour location

Fraction LAT mean (mm)
 p value LONG mean (mm)
 p value VERT mean (mm)
 p value
Central Peripheral Central Peripheral Central Peripheral
1st 0.71 1.77 0.048 1.18 3.91 0.002 1.12 1.32 NS
10th 0.76 1.77 0.008 1.53 2.41 NS 1.41 1.86 0.017
15th 1.47 1.55 NS 2.59 2.32 NS 1.35 1.45 NS
20th 1.94 1.27 NS 2.29 3.14 NS 1.29 1.09 NS

Mean set-up deviation difference (DD) comparison according to spine/target vs. carina/target registration

LAT deviation mean (mm)
 LONG deviation mean (mm)
 VRT deviation mean (mm)
Fraction Spine/target Carina/target DD p value Spine/target Carina/target DD p value Spine/target Carina/target DD p value
1st 1.28 0.90 0.38 NS 2.65 1.80 0.85 NS 1.20 1.43 -0.23 NS
10th 1.30 1.08 0.22 NS 2.03 1.53 0.50 NS 1.68 1.10 0.58 0.04
15th 1.48 1.08 0.4 NS 2.38 1.65 0.73 0.05 1.38 1.38 0 NS
20th 1.53 1.05 0.48 NS 2.73 2.15 0.58 NS 1.2 1.43 -0.23 NS
All measurements 1.39 1.03 0.37 0.003 2.44 1.78 0.66 0.002 1.36 1.33 0.03 NS

Patients, disease, and treatment characteristics

N = 40
Gender Female 16 (40 %)
Male 24 (60 %)
Age (years) Median (range) 67 (53–81)
RUL 15 (37.5%)
RML 3 (7.5%)
Tumour location* RLL 7 (17.5%)
LUL 8 (20%)
LLL 8 (20%)
Central (C)/ C 17 (42.5%)
peripheral (P) tumour location** P 22 (55%)
Histology NSCLC 31 (77.5%)
SCLC 9 (22.5%)
De novo lung cancer 32 (80%)
Local progression 1 (2.5%)
Disease treated Local recurrence reirradiation 2 (5%)
Regional recurrence 1 (2.5%)
Locoregional recurrence reirradiation 4 (10%)
Concurrent chemotherapy 13 (32.5%)
Systemic treatment Sequential chemotherapy 16 (40%)
Target therapy 1 (2.5%)
None 10 (25%)
T0 1 (2.5%)
T1 4 (10%)
Tumour (T) stage T2 14 (35%)
T3 8 (20%)
T4 13 (32.5%)
N0 9 (22.5%)
Lymph nodes (N) N1 1 (2.5%)
stage N2 14 (35%)
N3 16 (40%)
Fractionation Conventional 37 (92.5%)
Hypofractionation 3 (7.5%)
Radiation technique VMAT 40 (100%)

Carina/target registration deviation according to tumour location

Fraction LAT mean (mm) p value LONG mean (mm) p value VERT mean (mm) p value
Central Peripheral Central Peripheral Central Peripheral
1st 0.65 1.14 NS 1.65 2.00 NS 1.06 1.77 NS
10th 0.53 1.55 0.002 1.18 1.86 0.041 0.82 1.32 NS
15th 0.71 1.41 0.049 1.00 2.23 0.027 0.88 1.77 NS
20th 1.00 1.14 NS 0.94 3.14 0.019 0.88 1.82 NS
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