Sci-Sat AM: Stereo - 09: Accuracy of Liver Cancer Treatment on Cyberknife® with Synchrony™ Optical Tracking Throughout the Respiratory Cycle

Abstract

The Cyberknife® robotic stereotactic body radiation therapy system is well-suited for treating liver lesions over the respiratory cycle as it includes room-mounted orthogonal x-ray tracking of internal fiducial markers and optical tracking of external markers. The Synchrony™ software generates a model of internal target positions during patient respiration and correlates it to the external optical tracking system for real-time optical-based position corrections of the linear accelerator during beam delivery. Although clinical studies have provided preliminary outcomes for liver lesions treated with the Cyberknife system, to date, there is little data demonstrating the ability of the Synchrony software to track targets in the liver, which deforms throughout the respiratory cycle. In this study, we investigated the respiratory motion model performance for predicting tumour motion. We conducted a retrospective analysis of fifteen liver cancer patients treated on the Cyberknife using the Synchrony optical tracking system. We analyzed Cyberknife tracking information stored in the log files to extract the left-right (LR), anterior-posterior (AP) and superior-inferior (SI) correlation errors between the model-predicted position and the internal fiducial centroid position determined by x-ray imaging. Only translational tracking and corrections were applied during treatment. Overall, the correlation errors were greatest in the SI direction. We calculated radial correlation errors, and determined that the 95th, 98th and 99th percentile errors were 3.4 mm, 4.4 mm and 5.1 mm, respectively. Based on translational correlation tracking errors we expect the clinical target volume will be within 3.4 mm of the planning target volume for 95 % of beam delivery time.