MLC tracking for lung SABR is feasible, efficient and delivers high-precision target dose and lower normal tissue dose

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  • Jeremy Booth, Royal North Shore Hospital, University of Sydney
  • ,
  • Vincent Caillet, Royal North Shore Hospital, University of Sydney
  • ,
  • Adam Briggs, Royal North Shore Hospital
  • ,
  • Nicholas Hardcastle, Peter Maccallum Cancer Centre, University of Wollongong
  • ,
  • Georgios Angelis, Royal North Shore Hospital, University of Sydney
  • ,
  • Dasantha Jayamanne, Royal North Shore Hospital, University of Sydney
  • ,
  • Meegan Shepherd, Royal North Shore Hospital
  • ,
  • Alexander Podreka, Royal North Shore Hospital
  • ,
  • Kathryn Szymura, Royal North Shore Hospital
  • ,
  • Doan Trang Nguyen, University of Sydney, University of Technology Sydney
  • ,
  • Per Poulsen
  • Ricky O'Brien, University of Sydney
  • ,
  • Benjamin Harris, Royal North Shore Hospital
  • ,
  • Carol Haddad, Royal North Shore Hospital
  • ,
  • Thomas Eade, Royal North Shore Hospital, University of Sydney
  • ,
  • Paul Keall, University of Sydney

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.

OriginalsprogEngelsk
TidsskriftRadiotherapy and Oncology
Vol/bind155
Sider (fra-til)131-137
Antal sider7
ISSN0167-8140
DOI
StatusUdgivet - feb. 2021

Bibliografisk note

Funding Information:
The authors acknowledge Varian Medical Systems and Royal North Shore Hospital No2 Trust for supporting this study.

Publisher Copyright:
© 2020 The Author(s)

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

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