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Related Concept Videos

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Related Experiment Video

Updated: May 2, 2026

Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy
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Association Between Inter-Fraction Volume Changes and Patient Outcomes from Stereotactic Ablative Radiotherapy for

Wilson X Mai1, Melissa A Frick2, Scott Jackson1

  • 1Department of Radiation Oncology, Stanford University, Stanford, CA.

Clinical Lung Cancer
|November 15, 2025
PubMed
Summary

Inter-fraction volume changes are common in lung stereotactic ablative body radiotherapy (SABR) for non-small cell lung cancer (NSCLC). Increased volume correlated with reduced regional and distant recurrence, suggesting an inflammatory response rather than tumor growth.

Keywords:
Clinical outcomesDistant recurrenceLocal recurrenceNSCLCRegional recurrence

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Clinical Oncology

Background:

  • Inter-fraction volume changes during lung stereotactic ablative body radiotherapy (SABR) for early-stage non-small cell lung cancer (NSCLC) are not well understood.
  • This study is the largest to date investigating the clinical significance of these volume changes and their impact on disease control.

Purpose of the Study:

  • To investigate the clinical significance of inter-fraction volume changes during lung SABR for early-stage NSCLC.
  • To determine the association between volumetric changes and clinical outcomes, including local, regional, and distant recurrence.

Main Methods:

  • A cohort of 121 NSCLC patients treated with SABR between 2009 and 2019 was analyzed.
  • Gross tumor volume (GTV) and inter-fraction volumes (from cone-beam CT) were calculated.
  • Statistical analyses, including univariable/multivariable regression and Fine-Gray models, assessed relationships between volume changes and recurrence, with death as a competing risk.

Main Results:

  • Over half of tumors (61.9%) showed a >10% volume increase during treatment; 11.1% showed a decrease.
  • No significant correlation was found between volume increase and local recurrence.
  • Increased inter-fraction volume was negatively associated with regional and distant recurrence.

Conclusions:

  • Significant radiographic volume changes are common in lung SABR for NSCLC.
  • These volume changes do not appear to negatively impact local tumor control.
  • Increased radiographic volume may be linked to reduced regional and distant recurrence, potentially due to an immune response, suggesting that modest planning target volume (PTV) expansions might suffice.