SBRT of lung tumorsA comparison of two immobilization systems for stereotactic body radiation therapy of lung tumors
Section snippets
Patient eligibility
Ethical approval for this study was obtained from the research ethics board of Sunnybrook Health Sciences Center. Between October 2008 and July 2009, 24 consecutive patients undergoing lung SBRT at Sunnybrook Health Sciences Center were prospectively entered into the study. Patients were eligible for the study if they had stage I NSCLC or lung oligometastases suitable for SBRT with curative intent, and were medically inoperable or refused surgery. The maximum tumor diameter had to be ⩽5 cm.
Patient and tumor characteristics
Twenty-four patients with stage I NSCLC or oligometastases in the lung were enrolled onto the study. Median age was 75 (range 54–89). There were 13 male and 11 female patients. Twenty patients had medically inoperable disease due to poor lung function and/or co-morbidities and four refused surgery. One patient had two lung lesions. The distribution of tumor location was: three left upper lobe, two left lower lobe, 13 right upper lobe, two right middle lobe and five right lower lobe (Fig. 2).
Discussion
This study is the first to compare the efficacy (reducing respiratory and intrafraction tumor motion), efficiency (setup time) and comfort level of two SBRT immobilization systems: the Bodyfix and the ACP. Our findings indicate that the ACP is superior to the Bodyfix in reducing SI and overall respiratory tumor motion, faster to set up, and more comfortable than the Bodyfix. There is no significant difference between the Bodyfix and ACP in reducing intrafraction tumor motion.
Free breathing
Conclusion
Although there is no significant difference between the Bodyfix and ACP in reducing intrafraction tumor motion, the ACP is superior to the Bodyfix in terms of its efficacy in reducing SI and overall respiratory tumor motion, efficiency and comfort level. As such, the ACP may be the preferred method of immobilization for patients undergoing SBRT for lung tumors.
Conflict of interest statement
The authors declare that conflicts of interest do not exist.
Acknowledgements
We thank patients who participated in this study, and Darby Erler, Ada Wong, Naila Devji, Derek Hyde and radiation therapists at Sunnybrook Health Sciences Center for their assistance.
References (26)
- et al.
Incidence of local recurrence and second primary tumors in resected stage I lung cancer
J Thorac Cardiovasc Surg
(1995) - et al.
Prognosis and survival in resected lung carcinoma based on the new international staging system
J Thorac Cardiovasc Surg
(1988) Revisions in the international system for staging lung cancer
Chest
(1997)- et al.
The role of radiotherapy in treatment of stage I non-small cell lung cancer
Lung Cancer
(2003) - et al.
Radiation therapy in the management of medically inoperable carcinoma of the lung: results and implications for future treatment strategies
Int J Radiat Oncol Biol Phys
(1992) - et al.
Radiation therapy alone for stage I non-small cell lung cancer
Int J Radiat Oncol Biol Phys
(1993) - et al.
Radiotherapy alone for medically inoperable stage I non-small-cell lung cancer: the Duke experience
Int J Radiat Oncol Biol Phys
(1998) - et al.
Four-dimensional computed tomography scan analysis of tumor and organ motion at varying levels of abdominal compression during stereotactic treatment of lung and liver
Int J Radiat Oncol Biol Phys
(2008) - et al.
Use of maximum intensity projections (MIP) for target volume generation in 4DCT scans for lung cancer
Int J Radiat Oncol Biol Phys
(2005) - et al.
Design of 4D treatment planning target volumes
Int J Radiat Oncol Biol Phys
(2006)
Digital fluoroscopy to quantify lung tumor motion: Potential for patient-specific planning target volumes
Int J Radiat Oncol Biol Phys
What margins should be added to the clinical target volume in radiotherapy treatment planning for lung cancer
Radiother Oncol
Portal imaging to assess set-up errors, tumor motion and tumor shrinkage during conformal radiotherapy of non-small cell lung cancer
Radiother Oncol
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