Intra- and inter-fractional liver and lung tumor motions treated with SBRT under active breathing control

To assess intra- and inter-fractional motions of liver and lung tumors using active breathing control (ABC).

Nineteen patients with liver cancer and 15 patients with lung cancer treated with stereotactic body radiotherapy (SBRT) were included in this retrospective study. All patients received a series of three CTs at simulation to test breath-hold reproducibility. The centroids of the whole livers and of the lung tumors from the three CTs were compared to assess intra-fraction variability. For 15 patients (8 liver, 7 lung), ABC-gated kilovoltage cone-beam CTs (kV-CBCTs) were acquired prior to each treatment, and the centroids of the whole livers and of the lung tumors were also compared to those in the planning CTs to assess inter-fraction variability.

Liver intra-fractional systematic/random errors were 0.75/0.39 mm, 1.36/0.97 mm, and 1.55/1.41 mm at medial-lateral (ML), anterior-posterior (AP), and superior-inferior (SI) directions, respectively. Lung intra-fractional systematic/random errors were 0.71/0.54 mm (ML), 1.45/1.10 mm (AP), and 3.95/1.93 mm (SI), respectively. Substantial intra-fraction motions (>3 mm) were observed in 26.3% of liver cancer patients and in 46.7% of lung cancer patients. For both liver and lung tumors, most inter-fractional systematic and random errors were larger than the corresponding intra-fractional errors. However, these inter-fractional errors were mostly corrected by the treatment team prior to each treatment based on kV CBCT-guided soft tissue alignment, thereby eliminating their effects on the treatment planning margins.

Intra-fractional motion is the key to determine the planning margins since inter-fractional motion can be compensated based on daily gated soft tissue imaging guidance of CBCT. Patient-specific treatment planning margins instead of recipe-based margins were suggested, which can benefit mostly for the patients with small intra-fractional motions.