Respiratory motion management for external radiotherapy: 2025 update.

Area of Science:

• Radiation Oncology
• Medical Physics
• Cancer Treatment

Background:

• Respiratory motion introduces significant uncertainties in radiotherapy for thoracic and abdominal tumors.
• Tumor motion (1-3cm) impacts imaging, target delineation, and dose delivery accuracy.
• Effective respiratory motion management is vital for precise radiotherapy.

Purpose of the Study:

• To update the review on respiratory management in radiotherapy.
• To focus on emerging technologies and clinical implementations for motion management.
• To highlight advancements in precision radiotherapy for thoracic and abdominal cancers.

Main Methods:

• Review of established techniques: deep inspiration breath-hold, internal target volume (ITV), gating, real-time tracking.
• Inclusion of emerging technologies: intelligent 4D CT, MRI-guided LINACs, surface-guided radiotherapy.
• Analysis of dosimetric studies and quality assurance protocols.

Main Results:

• Advanced technologies enhance imaging quality and treatment precision.
• Dosimetric studies confirm reduced radiation exposure to healthy tissues.
• Clinical outcome data comparing techniques remain limited, requiring further research.

Conclusions:

• Successful integration requires interdisciplinary collaboration and patient-specific strategies.
• Emerging methods like advanced MRI-based gating refine motion management.
• Addressing respiratory motion improves tumor targeting, reduces toxicity, and enhances cancer treatment efficacy.