Measurement of Intra-Fraction Displacement of the Mediastinal Metastatic Lymph Nodes Using Four-Dimensional CT in Non-Small Cell Lung Cancer
Korean Journal of Radiology 2012³â 13±Ç 4È£ p.417 ~ p.424
(Wang Suzhen) - Shandong Cancer Hospital & Institute Department of Radiation Oncology
(Li Jianbin) - Shandong Cancer Hospital & Institute Department of Radiation Oncology
(Zhang Yingjie) - Shandong Cancer Hospital & Institute Department of Radiation Oncology
(Wang Wei) - Shandong Cancer Hospital & Institute Department of Radiation Oncology
(Li Fengxiang) - Shandong Cancer Hospital & Institute Department of Radiation Oncology
(Fan Tingyong) - Shandong Cancer Hospital & Institute Department of Radiation Oncology
(Xu Min) - Shandong Cancer Hospital & Institute Department of Radiation Oncology
(Shao Qian) - Shandong Cancer Hospital & Institute Department of Radiation Oncology
Abstract
Objective: To measure the intra-fraction displacements of the mediastinal metastatic lymph nodes by using four-dimensional CT (4D-CT) in non-small cell lung cancer (NSCLC).
Materials and Methods: Twenty-four patients with NSCLC, who were to be treated by using three dimensional conformal radiation therapy (3D-CRT), underwent a 4D-CT simulation during free breathing. The mediastinal metastatic lymph nodes were delineated on the CT images of 10 phases of the breath cycle. The lymph nodes were grouped as the upper, middle and lower mediastinal groups depending on the mediastinal regions. The displacements of the center of the lymph node in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were measured.
Results: The mean displacements of the center of the mediastinal lymph node in the LR, AP, and SI directions were 2.24 mm, 1.87 mm, and 3.28 mm, respectively. There were statistically significant differences between the displacements in the SI and LR, and the SI and AP directions (p < 0.05). For the middle and lower mediastinal lymph nodes, the displacement difference between the AP and SI was statistically significant (p = 0.005; p = 0.015), while there was no significant difference between the LR and AP directions (p < 0.05).
Conclusion: The metastatic mediastinal lymph node movements are different in the LR, AP, and SI directions in patients with NSCLC, particularly for the middle and lower mediastinal lymph nodes. The spatial non-uniform margins should be considered for the metastatic mediastinal lymph nodes in involved-field radiotherapy.
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Non-small cell lung cancer, Four-dimensional computed tomography, Mediastinal lymph nodes, Displacement measurement
KMID :
0880420120130040417
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The mediastinal lymph node displacements vary widely in different directions during free breathing; this study found that the mean displacements of 53 metastatic mediastinal lymph nodes in the SI, AP and LR directions were 3.28 mm, 1.87 mm, and 2.24 mm, respectively; Radiation therapy for the mediastinal lymph nodes is an important therapeutic component in the patients with locally advanced NSCLC.