Assessment of intrafractional motion in lung SBRT treatment
DOI:
https://doi.org/10.29384/rbfm.2025.v19.19849001787Keywords:
medical physics, radiotherapy, lung SBRT, cone beam-CTAbstract
The global impact of cancer on public health is alarming, leading to a significant increase in incidence and mortality, including in Brazil, where an increase to approximately 704 thousand new cases between 2023 and 2025 is projected. Lung cancer is one of the most common forms of the disease, affecting both men and women. Radiotherapy plays a crucial role in the treatment of lung cancer, harnessing technological advancements to improve precision and minimize side effects. The technique of Stereotactic Body Radiotherapy (SBRT) has emerged as an effective approach, especially for patients who are not candidates for surgery. However, respiratory motion can compromise the accuracy of radiation delivery, requiring the use of respiratory management techniques and 4DCT imaging to ensure treatment accuracy. Cone-Beam Computed Tomography (CBCT) plays a fundamental role in error correction during the treatment process. At the National Cancer Institute (INCA), SBRT has been applied since 2014, with rigorous verification protocols before each radiotherapy session. Recent studies have focused on intrafraction target motion during lung SBRT, aiming to enhance treatment effectiveness and reduce adverse effects. A prospective analysis of the total treatment time of six patients undergoing lung SBRT highlighted the importance of immobility during the procedure. The results revealed small patient displacements, which did not have a significant impact on dose distribution, as the displacements were within the adopted margin and without radiation dosimetric impairments. Although the current 5 mm PTV margin used at INCA is considered appropriate, further research is needed to determine whether a reduction of this margin can further improve outcomes for patients.
Downloads
References
SUNG, H. et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer Journal for Clinicians, Hoboken, v. 71, n. 3, p. 209-249, Feb. 2021. DOI 10.3322/caac.21660.
Pereira, V. S., & da Silva, B. N. (2023). Saúde Pública: princípios e práticas. Livros da Editora Integrar.
Instituto Nacional Do Câncer José Alencar Gomes Da Silva (INCA). Estimativa 2023-2025. Incidência de câncer no Brasil. Rio de Janeiro, 2022.
Timmerman RD, Paulus R, Pass HI, Gore EM, Edelman MJ, Galvin J, et al. Stereotactic Body Radiation Therapy for Operable Early-Stage Lung Cancer: Findings From the NRG Oncology RTOG 0618 Trial. JAMA Oncol. 2018 Sep 1;4(9):1263-1266. doi: 10.1001/jamaoncol.2018.1251.
BENEDICT, Stanley H. et al. Stereotactic body radiation therapy: the report of AAPM Task Group 101. Medical physics, v. 37, n. 8, p. 4078-4101, 2010.
Chi A, Liao Z, Nguyen NP, Xu J, Stea B, Komaki R. Systemic review of the patterns of failure following stereotactic body radiation therapy in early-stage non-small-cell lung cancer: clinical implications. Radiother Oncol. 2010 Jan;94(1):1-11. doi: 10.1016/j.radonc.2009.12.008. Epub 2010 Jan 13.
Timmerman R, McGarry R, Yiannoutsos C, et al. Excessive toxicity when treating central tumors in a phase II study of stereotacticbodyradiationtherapy for medically inoperable early-stage lung cancer. J Clin Oncol.24(30): 4833-9, 2006.
Radiation Therapy Oncology Group. 2015 Jun 22 - RTOG 0813 Protocol Information, Seamless phase I/II study of stereotactic lung radiotherapy (SBRT) for early stage, centrally located, non-small cell lung cancer (NSCLC) in medically inoperable patients. Philadelphia: RTOG; Jun, 2015.
Kim B, Kirkby C, Semaka A, Debenham B, Campbell T. Assessment of IGRT variability for lung SBRT. J Med Imaging Radiat Sci. 2021 Jun;52(2):191-197. doi: 10.1016/j.jmir.2021.02.004. Epub 2021 Mar 8.
Benkhaled S, Koshariuk O, Van Esch A, Remouchamps V. Characteristics and dosimetric impact of intrafraction motion during peripheral lung cancer stereotactic radiotherapy: is a second midpoint cone beam computed tomography of added value? Rep Pract Oncol Radiother. 2022 Jul 29;27(3):490-499.
doi: 10.5603/RPOR.a2022.0047.
Luo W, Xiu Z, Wang X, McGarry R, Allen J. A Novel Method for Evaluating Early Tumor Response Based on Daily CBCT Images for Lung SBRT. Cancers (Basel). 2023 Dec 19;16(1):20. doi: 10.3390/cancers16010020
Schwarz M, Cattaneo GM, Marrazzo L. Geometrical and dosimetrical uncertainties in hypofractionated radiotherapy of the lung: A review. Phys Med. 2017 Apr36:126-139. doi: 10.1016/j.ejmp.2017.02.011.
Huang L, Park K, Boike T, Lee P, Papiez L, Solberg T, Ding C, Timmerman RD. A study on the dosimetric accuracy of treatment planning for stereotactic body radiation therapy of lung cancer using average and maximum intensity projection images. RadiotherOncol. 2010 Jul;96(1):48-54. doi: 10.1016/j.radonc.2010.04.003.
Wang L, Feigenberg S, Fan J, Jin L, Turaka A, Chen L, et al. Target repositional accuracy and PTV margin verification using three-dimensional cone-beam computed tomography (CBCT) in stereotactic body
radiotherapy (SBRT) of lung cancers. J Appl Clin Med Phys. 2012 Mar 8;13(2):3708. doi: 10.1120/jacmpv13i2.3708.
Brandner ED, Chetty IJ, Giaddui TG, Xiao Y, Huq MS. Motion management strategies and technical issues associated with stereotactic body radiotherapy of thoracic and upper abdominal tumors: A review from NRG oncology. MedPhys. 2017 Jun;44(6):2595-2612. doi: 10.1002/mp.12227.
Freislederer P, Reiner M, Hoischen W, Quanz A, Heinz C, Walter F, Belka C, Soehn M. Characteristics of gated treatment using an optical surface imaging and gating system on an Elekta linac. Radiat Oncol. 2015 Mar 19;10:68. doi: 10.1186/s13014-015-0376-x.
Guerrero E, Ahmed M. The role of stereotactic ablative radiotherapy (SBRT) in the management of oligometastatic non small cell lung cancer. Lung Cancer. 2016 Feb;92:22-8. doi: 10.1016/j.lungcan.2015.11.015.
Carducci MP, Sundaram B, Greenberger BA, Werner-Wasik M, Kane GC. Predictors and characteristics of Rib fracture following SBRT for lung tumors. BMC Cancer. 2023 Apr 12;23(1):337. doi: 10.1186/s12885-023-10776-8.
Yeager C, Lin H, Ayan A, McDonough J, Both S. A Study to Establish the Effect of CBCT Image Rotational Displacement on IGRT and ART Lung SBRT Treatments. MedPhys. 2012 Jun;39(6Part6):3655. doi: 10.1118/1.4734846.
Guckenberger M, Andratschke N, Dieckmann K, Hoogeman MS, Hoyer M, Hurkmans C, et al.. ESTRO ACROP consensus guideline on implementation and practice of stereotactic body radiotherapy for peripherally located early stage non-small cell lung cancer. Radiother Oncol. 2017 Jul;124(1):11-17. doi:
1016/j.radonc.2017.05.012.
Takahashi W, Yamashita H, Kida S, Masutani Y, Sakumi A, Ohtomo K, et al. A. Verification of planning target volume settings in volumetric modulated arctherapy for stereotactic body radiation therapy by using in-treatment 4-dimensional cone beam computed tomography. Int J Radiat Oncol Biol Phys. 2013 Jul 1;86(3):426-31. doi: 10.1016/j.ijrobp.2013.02.019.
Coronado-Delgado DA,Garnica-Garza HM. Combined Mega voltage and Contrast-Enhanced
radiotherapy as an Intrafraction Motion Management Strategy in Lung SBRT. TechnolCancer Res Treat. 2019 doi: 10.1177/1533033819883639.
Depuydt T, Poels K, Verellen D, Engels B, Collen C, Buleteanu M, et al. Treating patient swith real-time tumor tracking using the Vero gimbaled linac system: implementation and first review. Radiother Oncol. 2014 Sep;112(3):343-51. doi: 10.1016/j.radonc.2014.05.017.
Gill A, Hirst AL, Rowshanfarzad P, Gill S, Bucknell N, Dass J, Sabet M. Stereotactic body radiotherapy for early-stage lung cancer: a systematic review on the choice of photon energy and linac flattened/unflattened beams. RadiatOncol. 2024 Jan 2;19(1):1. doi: 10.1186/s13014-023-02392-4.
Daly ME, Beagen P, Madani MH. Nonsurgical Therapy for Early-Stage Lung Cancer. Hematol Oncol Clin North Am. 2023 Jun;37(3):499-512. doi: 10.1016/j.hoc.2023.02.002
Yang M, Timmerman R. Stereotactic Ablative Radiotherapy Uncertainties: Delineation, Setup and Motion. Semin Radiat Oncol. 2018 Jun;28(3):207-217. doi: 10.1016/j.semradonc.2018.02.006.
Videtic GM, Paulus R, Singh AK, Chang JY, Parker W, Olivier KR, et al. Long-term Follow-up on NRG Oncology RTOG 0915 (NCCTG N0927): A Randomized Phase 2 Study Comparing 2 Stereotactic Body Radiation Therapy Schedules for Medically Inoperable Patients With Stage I Peripheral Non-Small Cell
Lung Cancer. Int J Radiat Oncol Biol Phys. 2019 Apr 1;103(5):1077-1084. doi: 10.1016/j.ijrobp.2018.11.051.
van Herk M, Remeijer P, Rasch C, Lebesque JV. The probability of correct target dosage: dose-population histograms for deriving treatment margins in radiotherapy. Int J Radiat Oncol Biol Phys. 2000 Jul 1;47(4):1121-35. doi: 10.1016/s0360-3016(00)00518-6.
Stroom J, Vieira S, Mateus D, Greco C, Fogliata A, Nicolini G, et al. On the robustness of VMAT-SABR treatment plans against isocentre positioning uncertainties. Radiat Oncol. 2014 Sep5;9:196. doi: 10.1186/1748-717X-9-196.
Remeijer P, Rasch C, Lebesque JV, van Herk M. Margins for translational and rotational uncertainties: a probability-based approach. Int J Radiat Oncol Biol Phys. 2002 Jun 1;53(2):464- 74. doi: 10.1016/s0360-3016(02)02749-9.
Bellec J, Arab-Ceschia F, Castelli J, Lafond C, Chajon E. ITV versus mid-ventilation for treatment planning in lung SBRT: a comparison of target coverage and PTV adequacy by using intreatment 4D cone beam CT. Radiat Oncol. 2020 Mar 3;15(1):54. doi: 10.1186/s13014-020-01496-5.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Valquiria Guimarães Pereir
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The submission of original articles to the Brazilian Journal of Medical Physics implies the transfer, by the authors, of the rights of print and digital publication. Copyright for published articles remains with the author, with journal rights on first publication. Authors may only use the same results in other publications by clearly indicating this journal as the original publisher. As we are an open access journal, free use of articles in educational, scientific, non-commercial applications is allowed, as long as the source is cited.
The Brazilian Journal of Medical Physics is under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).
