[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-436452-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-436452-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","liver-directed-stereotactic-body-radiotherapy-without-internal-fiducial-markers-a-case-series","Liver-directed stereotactic body radiotherapy without internal fiducial markers - A case series","","Liver-directed stereotactic body radiotherapy (SBRT) faces limitations from respiratory tumor motion and limited tissue-tumor contrast. This case series evaluates liver-directed SBRT without internal fiducial markers using expiratory breath hold combined with diaphragm matching and breath-hold diaphragm matching assessment. One hundred thirty-four volumetric images from 13 consecutive patients were compared. Local control remained high at 1 and 2 years, with reproducibility differences between matching strategies.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/liver-directed-stereotactic-body-radiotherapy-without-internal-fiducial-markers-a-case-series/436452/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/liver-directed-stereotactic-body-radiotherapy-without-internal-fiducial-markers-a-case-series/436452.png","ImageObject",300,407,{"name":42,"@type":43},"Connor ","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-31","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",8,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What problem does this study address in liver-directed SBRT?","Question",{"text":63,"@type":64},"Tumor motion and limited tissue-tumor contrast make liver-directed SBRT technically challenging. The study focuses on delivering SBRT without internal fiducial markers while managing respiratory motion.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How does the study perform positioning without internal fiducial markers?",{"text":68,"@type":64},"It investigates expiratory breath hold together with diaphragm matching, using diaphragm position as a surrogate for tumor positioning and evaluating reproducibility across fractions.",{"name":70,"@type":61,"acceptedAnswer":71},"What follow-up outcomes are reported for local control?",{"text":72,"@type":64},"At a median follow-up of 13 months, the 1-year and 2-year local control rates for index lesions were 90% and 72%, respectively.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},436452,1790862609,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":97,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},687207022233,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","J Chin MedAssoc  \nBrief CommuniCation  \nLiver-directed stereotactic body radiotherapy can be reliably delivered to selected patients without internal fiducial markers—A case series  \nHsiao-Ju Fua, Po-Yueh Chenb, Hsin-Yi Yangc, Yuk-Wah Tsanga, Cheng-Yen Leea,*  \naDepartment of Radiation Therapy and Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC; bDepartment of Internal Medicine, Ditmanson Medication Foundation, Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC; cClinical Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC  \nAbstract  \nTumor motion and the lack of tissue-tumor contrast have been challenging parts of liver-directed stereotactic body radiotherapy (SBRT) . In this study, we investigated the possibility of liver-directed SBRT without internal fiducials using breath hold technique and diaphragm matching technique. One hundred thirty-four volumetric images of 13 consecutive patients with either primary or metastatic liver tumors who underwent expiratory breath hold SBRT were compared and analyzed. Reproducibility of diaphragm position between fractions relative to bone was evaluated on image registration software. At median follow-up time of 13 months, 1-year and 2-year local control rates of index lesions were 90% and 72%, respectively. In comparison to diaphragm matching, a greater margin is required for bone matching technique for that 19 of 67 (28%) of all interfractional SI offsets were more than 6 mm, whereas 6 of 67 (9%) intrafractional SI exceeded 6 mm. Despite the small study size, our study showed that breath hold SBRT without internal hepatic fiducial is a valid approach for selected patients.  \nKeywords: Abches; Breath hold; Fiducial; Hepatic tumor; Stereotactic body radiotherapy  \n1. INTRODUCTION  \nHepatic tumors, either primary or metastatic malignancies, can be effectively treated with stereotactic body radiotherapy (SBRT) .1 Yet liver-directed SBRTs remained technically challenging for the combination of lack of tissue contrast on computed tomography (CT) and respiration related tumor motion.2  \nBreath hold technique has been proposed to minimize organ motion, with expiratory breath hold being superior in terms of reproducibility.3-5 Surrogate markers for tumor positioning during treatment such as invasive internal fiducial and radioopacities either has inherent risks or are not readily available.6-8 The liver dome, however, is always present, and has been shown to correlate with actual tumor position.9  \nClinical outcomes on liver-directed SBRTs without implant fiducial or radio-opaque markers at index lesions are lacking. The purpose of this study is to illustrate the potential of liverdirected SBRTs using diaphragm as surrogate tumor positioning under expiratory breath hold.  \n* Address Correspondence. Dr. Cheng-Yen Lee, Department of Radiation Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 539, Zhongxiao Road, East Dist., Chiayi 600, Taiwan, ROC. E-mail address: 07463@ [cych.org.tw](cych.org.tw) (C.-Y. Lee).  \nConflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.  \nJournal of Chinese Medical Association. (2022) 85: 1028-1032.  \nReceived September 1, 2021; accepted August 7, 2022.  \ndoi: 10. 1097/JCMA.0000000000000798.  \nCopyright © 2022, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/))  \n2. METHODS  \nInstitutional Research Ethics Board approval was obtained prior to study initiation (institution and certification number: IRB2019087) . For this case series, electronic medical records and images of 13 consecutive patients, who underwent hepatic SBRT without internal fiducial between January 2018 and December 2020,","cbCaikhxpK7qhjHV","https://ap.wps.com/l/cbCaikhxpK7qhjHV","pdf",571828,"English","# Abstract\n# 1. Introduction\n# 2. Methods\n## 2.1. End-expiratory breath hold technique and monitoring\n## 2.2. Treatment planning and radiotherapy technique","[{\"question\":\"What problem does this study address in liver-directed SBRT?\",\"answer\":\"Tumor motion and limited tissue-tumor contrast make liver-directed SBRT technically challenging. The study focuses on delivering SBRT without internal fiducial markers while managing respiratory motion.\"},{\"question\":\"How does the study perform positioning without internal fiducial markers?\",\"answer\":\"It investigates expiratory breath hold together with diaphragm matching, using diaphragm position as a surrogate for tumor positioning and evaluating reproducibility across fractions.\"},{\"question\":\"What follow-up outcomes are reported for local control?\",\"answer\":\"At a median follow-up of 13 months, the 1-year and 2-year local control rates for index lesions were 90% and 72%, respectively.\"}]","Liver-directed stereotactic body radiotherapy without internal fiducial markers - A case series | PDF",1790677996,13]