Advances in the use of motion management and image guidance in radiation therapy treatment for lung cancer

Abstract

The development of advanced radiation technologies, including intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and proton therapy, has resulted in increasingly conformal radiation treatments. Recent evidence for the importance of minimizing dose to normal critical structures including the heart and lungs has led to incorporation of these advanced treatment modalities into radiation therapy (RT) for non-small cell lung cancer (NSCLC). While such technologies have allowed for improved dose delivery, implementation requires improved target accuracy with treatments, placing increasing importance on evaluating tumor motion at the time of planning and verifying tumor position at the time of treatment. In this review article, we describe issues and updates related both to motion management and image guidance in the treatment of NSCLC.

Online adaptive dose restoration in intensity modulated proton therapy of lung cancer to account for inter-fractional density changes

“…For online adaptation, extensive quality assurance (QA) of tools as auto-contouring [32] , [33] or automated planning techniques [34] , [35] would be needed. A possible solution for (2) could be other registration strategies such as soft-tissue or carina-based positioning [36] . Bony registration could be preferred in current practice for ensuring correct alignment of the bones with respect to proton paths and avoid dose distortions.…”

Vinte anos de avanços na Radioterapia Torácica

“…Ambos podem levar a uma entrega mais precisa do tratamento, com a possibilidade de diminuir as margens de PTV (Figura 5.). Sabemos que alterações anatómicas durante a RT podem modificar a cobertura do volume -alvo em cerca de 26% dos doentes 64,65 .…”

Three discipline collaborative radiation therapy (3DCRT) special debate: I would treat all early‐stage NSCLC patients with SBRT

“…Second, advances in motion management and image guidance have broadened the scope for the use of SBRT for centrally located and/or larger tumors . These include the increased use of four‐dimensional (4D) CT, in‐room image‐guidance based on cone‐beam CT, CT on‐rails, recently developed integrated MRI + radiotherapy machines, and real‐time position monitoring (optical markers, abdominal belts, surface photogrammetry).…”

“…Understanding and experience of respiratory motion management and associated motion management technology have vastly improved. Such improvements include routine use of 4D CT for simulation, advances in dose calculation algorithms and treatment plan optimization, routine use of cone‐beam CT for in‐room localization, and on‐line real‐time surrogate‐based or image‐based position monitoring for better spatiotemporal localization of the tumor with respect to surrounding OARs . Prospective clinical trials such as RTOG 0813 have demonstrated in a phase −1/2 setting, the relative safety of using five fraction SBRT regimens for central and ultracentral tumors .…”