Motion Management for Radical Radiotherapy in Non-small Cell Lung Cancer

A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer

“…[4][5][6][7][8][9] In order to deliver ablative doses of RT to tumours, it is necessary to accurately identify both the target and the surrounding organs at risk (OARs), in addition to accommodating inter-and intrafraction movement of both. 10 The three key components required to achieve this involve patient immobilization, on-treatment image guidance and ontreatment patient motion management. 11 With the use of four-dimensional CT scanning for planning of the tumour motion, and image guidance with cone beam CT during treatment delivery, uncertainties/errors have been reduced significantly, thus increasing the confidence in delivering hypofractionated radiation precisely.…”

Optimizing geometric accuracy of four-dimensional CT scans acquired using the wall- and couch-mounted Varian® Real-time Position Management™ camera systems

“…These breathing periods and amplitudes were selected to represent the clinically relevant range anticipated in radiotherapy delivery that would most benefit from 4DCT. 4 The QUASAR programmable respiratory motion v. 3.0 software was used to drive the phantom with a sinusoidal motion pattern. For both the wall-and couch-mounted camera systems, 4DCT scans were acquired of the phantom using the scan parameters shown in Table 1.…”

“…Other methods include the use of a mid-ventilation scan for outlining. 4,5 Accurate spatial representation of anatomy in each breathing phase is essential for the correct delineation of 4D target volumes. Further to this, 4D volumetric arc therapy (VMAT) has been proposed, 6 which requires accurate information on the position of the target throughout the breathing cycle of the patient.…”

“…Centre-specific approaches include the use of geometrical position, time-weighted average position, and average and maximum intensity projections (MIPs). 4 A common method is to use the MIP, combined with individual breathing phase images, to delineate an internal target volume (ITV) in lung tumours that includes identifiable disease as imaged over the full respiratory cycle. Other methods include the use of a mid-ventilation scan for outlining.…”

Surgery compared to stereotactic body radiation therapy for early-stage non-small cell lung cancer: better, equivalent or worse?

“…Respiratory movements make it difficult to apply the correct dose, especially for lesions located close to the diaphragm for which special techniques are required as breath-hold techniques, abdominal compression, respiratory tracking and respiratory gating (12).…”