PMC8202334_01
Computed tomography (CT) scanning diagnostic images of lung cancer and the treatment plan. (a) CT images revealed a solitary nodule of 20 mm in diameter in the lower lobe of the right lung (left panel). High 2-deoxy-2-[fluorine-18]fluoro-D-glucose (FDG) uptake by the tumour was observed in contrast imaging with positron emission tomography with FDG integrated with CT (18F-FDG PET/CT) images (right). (b) Stereotactic body radiation therapy (SBRT) plan was generated with a total of 48 Gy in four fractions for planning target volume (PTV). The colour washes indicate the dose distributions. (c) Results of tracking accuracy in stereotactic body radiation therapy for lung tumour (upper left). Tracking results at first simulation without coaching (upper right); results at second simulation with audio coaching (lower left); results at first treatment fraction (lower right) and results at treatment completion (fourth fraction). Findings indicate improvement in tracking accuracy after the first simulation. Parameters of interest (Potential Diff and Measured Delta) did not exceed threshold values for most of the treatment time. Treatment course was successfully completed.
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PMC8202334_01_10.1177_2050313X211023688-fig1.jpg
fig1-2050313X211023688
A CT scan performed in May 2020 revealed a 20-mm nodule in the right lower lobe (S8) (Figure 1(a), left). Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose CT (18F-FDG PET/CT) showed 12.6 of the maximum standardized uptake value (SUVmax) of the tumour without evidence of another abnormal uptake (Figure 1(a), right). The total prescribed radiation dose was 48 Gy in four fractions (Figure 1(b)). After audio coaching, PD values improved within 3 mm and treatment was successfully completed (Figure 1(c)).
PMC8202334_02
Diagnostic images and treatment plan for liver tumour. (a) The previous SBRT was prescribed at a dose of 40 Gy in five fractions (D95) for pathologically confirmed HCC in S4 of the liver. Dose distribution of previous stereotactic body radiation therapy was represented in the MIM Maestro version 7.0.3 (MIM Software Inc., Cleveland, OH, USA) from the digital imaging and communications in medicine-radiation therapy (DICOM-RT). (b) Portal venous tumour thrombosis (PVTT) observed close to the previously irradiated area in contrast-enhanced computed tomography (indicated by arrows). (c) Treatment plan with intensity-modulated radiation therapy for PVTT was generated at a total of 48 Gy in 20 fractions for planning target volume (PTV). (d) Combined dose distributions of previous and present radiotherapy defined in terms of biologically effective dose (BED), using a linear-quadratic model with an assumed alpha/beta ratio of 2 Gy for liver (BED2) (MIM Maestro). (e) Results of tracking accuracy in radiotherapy for liver tumour (upper left). The first simulation resulted in an unstable model (upper right); a stable model was achieved after changing the LED marker position from the chest wall to abdominal wall (lower left); results at first treatment fraction (lower right) and results at treatment completion (20th fraction). Parameters of interest (Potential Diff and Measured Delta) never exceeded threshold values, except for the first simulation. Treatment was successfully completed.
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PMC8202334_02_10.1177_2050313X211023688-fig2.jpg
fig2-2050313X211023688
A 68-year-old man presented with a history of alcoholic cirrhosis and treatments for hepatocellular carcinoma (HCC) administered between March 2016 and February 2020, including SBRT following implantation of a fiducial marker in March 2016 (Figure 2(a)). Contrast-enhanced CT scan was performed in June 2020, revealing multiple intrahepatic failures in the left lobe of the liver with portal venous tumour thrombosis (PVTT) in the left branch of the hepatic portal vein (Figure 2(b)). We prescribed radiation at a total dose of 48 Gy in 20 fractions for PVTT (Figure 2(c) and (d)). However, after changing the LED position from the chest wall to the abdominal wall, PD values improved within 3 mm, and the treatment was successfully completed (Figure 2(e)).