Investigation of intrafractional spinal cord and spinal canal movement during stereotactic MR-guided online adaptive radiotherapy for kidney cancer

• Published in: PloS one Vol. 19; no. 10; p. e0312032
• Main Authors: Yamamoto, Takaya, Tanaka, Shohei, Takahashi, Noriyoshi, Umezawa, Rei, Suzuki, Yu, Kishida, Keita, Omata, So, Takeda, Kazuya, Harada, Hinako, Sato, Kiyokazu, Katsuta, Yoshiyuki, Kadoya, Noriyuki, Jingu, Keiichi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 30.10.2024
• Subjects: Abdomen; Adult; Aged; Aged, 80 and over; Analysis; Biology and Life Sciences; Canals (anatomy); Cancer; Care and treatment; Consent; Contours; Correlation coefficient; Correlation coefficients; Diagnosis; Dose Fractionation, Radiation; Evaluation; Female; Formability; Health aspects; Humans; Image registration; Intervals; Kidney cancer; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - pathology; Kidney Neoplasms - radiotherapy; Kidneys; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical imaging; Medical research; Medicine and Health Sciences; Medicine, Experimental; Middle Aged; Movement; Patient outcomes; Patients; Physiological aspects; Position measurement; Radiation therapy; Radiosurgery; Radiosurgery - methods; Radiotherapy; Radiotherapy Planning, Computer-Assisted - methods; Radiotherapy, Image-Guided - methods; Registration; Research and Analysis Methods; Respiration; Spinal canal; Spinal Canal - diagnostic imaging; Spinal cord; Spinal Cord - diagnostic imaging; Spinal Cord - radiation effects; Spinal stenosis; Japan; Monaco; Sweden
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0312032

This study aimed to investigate the intrafractional movement of the spinal cord and spinal canal during MR-guided online adaptive radiotherapy (MRgART) for kidney cancer. All patients who received stereotactic MRgART for kidney cancer between February 2022 and February 2024 were included in this study. Patients received 30-42 Gy in 3-fraction MRgART for kidney cancer using the Elekta Unity, which is equipped with a linear accelerator and a 1.5 Tesla MRI. MRI scans were performed at three points during each fraction: for online planning, position verification, and posttreatment assessment. The spinal cord was contoured from the upper edge of Th12 to the medullary cone, and the spinal canal was contoured from Th12 to L3, using the first MRI. These contours were adjusted to the second and third MR images via deformable image registration, and movements were measured. Margins were determined via the formula "1.3×Σ+0.5×σ" and 95% prediction intervals. A total of 22 patients (66 fractions) were analyzed. The median interval between the first and third MRI scans were 38 minutes. The mean ± standard deviation of the spinal cord movements after this interval were -0.01 ± 0.06 for the x-axis (right-left), 0.01 ± 0.14 for the y-axis (caudal-cranial), 0.07 ± 0.05 for the z-axis (posterior-anterior), and 0.15 ± 0.08 for the 3D distance, respectively. The correlation coefficients of the 3D distance between the spinal cord and the spinal canal was high (0.92). The calculated planning organ at risk volume margin for all directions was 0.11 cm for spinal cord. The 95% prediction intervals for the x-axis, y-axis, and z-axis were -0.11-0.09 cm, -0.23-0.25 cm and -0.14-0.03 cm, respectively. Margins are necessary in MRgART to compensate for intrafractional movement and ensure safe treatment delivery.