MLC tracking for lung SABR is feasible, efficient and delivers high-precision target dose and lower normal tissue dose
- Author(s)
- Booth, J; Caillet, V; Briggs, A; Hardcastle, N; Angelis, G; Jayamanne, D; Shepherd, M; Podreka, A; Szymura, K; Nguyen, DT; Poulsen, P; O'Brien, R; Harris, B; Haddad, C; Eade, T; Keall, P;
- Journal Title
- Radiotherapy and Oncology
- Publication Type
- Research article
- Abstract
- BACKGROUND AND PURPOSE: The purpose of this work is to present the clinical experience from the first-in-human trial of real-time tumor targeting via MLC tracking for stereotactic ablative body radiotherapy (SABR) of lung lesions. METHODS AND MATERIALS: Seventeen patients with stage 1 non-small cell lung cancer (NSCLC) or lung metastases were included in a study of electromagnetic transponder-guided MLC tracking for SABR (NCT02514512). Patients had electromagnetic transponders inserted near the tumor. An MLC tracking SABR plan was generated with planning target volume (PTV) expanded 5 mm from the end-exhale gross tumor volume (GTV). A clinically approved comparator plan was generated with PTV expanded 5 mm from a 4DCT-derived internal target volume (ITV). Treatment was delivered using a standard linear accelerator to continuously adapt the MLC based on transponder motion. Treated volumes and reconstructed delivered dose were compared between MLC tracking and comparator ITV-based treatment. RESULTS: All seventeen patients were successfully treated with MLC tracking (70 successful fractions). MLC tracking treatment delivery time averaged 8 minutes. The time from the start of CBCT to the end of treatment averaged 22 minutes. The MLC tracking PTV for 16/17 patients was smaller than the ITV-based PTV (range -1.6% to 44% reduction, or -0.6 to 18 cc). Reductions in mean lung dose (27 cGy) and V20Gy (50 cc) were statistically significant (p < 0.02). Reconstruction of treatment doses confirmed a statistically significant improvement in delivered GTV D98% (p < 0.05) from planned dose compared with the ITV-based plans. CONCLUSION: The first treatments with lung MLC tracking have been successfully performed in seventeen SABR patients. MLC tracking for lung SABR is feasible, efficient and delivers high-precision target dose and lower normal tissue dose.
- Keywords
- *Carcinoma, Non-Small-Cell Lung/diagnostic imaging/radiotherapy/surgery; Humans; Lung; *Lung Neoplasms/radiotherapy/surgery; *Radiosurgery; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; *Radiotherapy, Intensity-Modulated; Adaptive radiotherapy; Lung SABR; MLC tracking
- Department(s)
- Physical Sciences
- PubMed ID
- 33152399
- Publisher's Version
- https://doi.org/10.1016/j.radonc.2020.10.036
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2025-06-13 06:48:02
Last Modified: 2025-06-13 06:48:45