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Margin calculation for multiple lung metastases treated with single-isocenter SBRT.

Janita E van Timmeren1, Mischa S Hoogeman2, Stefanie Ehrbar1

  • 1Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Switzerland.

Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology
|July 12, 2021
PubMed
Summary

Single-isocenter stereotactic body radiotherapy (SBRT) for multiple lung metastases requires accounting for inter-lesion position variation. Adjusting safety margins by less than 1 mm can compensate for these positional changes in lung SBRT.

Keywords:
Lung cancerMargin calculationSingle isocenter multiple targetsStereotactic body radiotherapy

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Oncology

Background:

  • Single-isocenter stereotactic body radiotherapy (SBRT) offers potential benefits for multiple lung metastases, including reduced patient dose and treatment time.
  • Accurate margin calculations for single-isocenter lung SBRT are crucial but currently lack consideration for inter-lesion position variation.

Purpose of the Study:

  • To quantify the inter-lesion position variation in multiple lung metastases.
  • To calculate appropriate safety margins for single-isocenter lung SBRT incorporating inter-lesion position variation.

Main Methods:

  • Utilized 83 pairs of pulmonary metastases from 42 NSCLC patients for analysis.
  • Calculated relative inter-lesion position variation using lesion-based registration of planning CT and verification CBCT.
  • Assessed van Herk's margin formula validity and calculated population-based margins.

Main Results:

  • Mean inter-lesion position variation was 1.2 ± 1.1 mm (3D-vector), increasing with non-pleural attachment or greater lesion distance.
  • Safety margins increased from 5.6, 5.8, 5.2 mm to 6.0, 6.6, 5.5 mm (AP, SI, LR) when inter-lesion variation was incorporated.
  • Simulations indicated random errors contributed 0.25∙σtot to the margin in the SI direction.

Conclusions:

  • Inter-lesion position variation in lung SBRT is influenced by inter-target distance and location.
  • Additional safety margins of less than 1 mm are sufficient to compensate for inter-lesion position variation in single-isocenter lung SBRT.