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Analysis of Surface Guidance Versus Laser Alignment for Precision Lung Cancer Particle Therapy
Xiyu Zhang1,2,3, Yuze Yang1,2,3, Jingfang Mao2,3,4
1Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China.
Technology in Cancer Research & Treatment
|February 17, 2026
Summary
Surface-guided radiotherapy (SGRT) significantly improves patient setup accuracy in lung cancer particle therapy. This advanced technique reduces setup errors, enhancing treatment precision for proton and carbon ion therapies.
Area of Science:
- Radiation Oncology
- Medical Physics
- Cancer Therapy
Background:
- Lung particle therapy, particularly pencil beam scanning, offers high dose conformity but is susceptible to geometric uncertainties.
- Surface-guided radiotherapy (SGRT) has shown promise in improving setup reproducibility for photon radiotherapy.
- Limited evidence exists on the clinical utility of SGRT in lung particle therapy workflows.
Purpose of the Study:
- To evaluate the clinical value of SGRT in enhancing six degrees of freedom (6-DOF) setup reproducibility for lung cancer patients undergoing particle therapy.
- To compare setup error reduction between conventional laser-based positioning and SGRT workflows.
Main Methods:
- Retrospective analysis of 1277 treatment fractions from 63 lung cancer patients (February 2023 - January 2024).
- Comparison between conventional laser-based (983 fractions) and SGRT (294 fractions) positioning methods.
- Manual registration of kV x-ray images with DRRs to calculate 6-DOF correction parameters and quantify pre-correction setup errors (translational and rotational).
Main Results:
- SGRT group showed statistically significant reductions in median shifts for lateral, longitudinal, pitch, and overall magnitude (MAG) compared to conventional methods.
- Improvements were more pronounced in supine-positioned patients; no significant differences were observed in prone patients.
- Substantial reductions in ninth decile and third quartile deviations were observed in the overall cohort with SGRT.
Conclusions:
- SGRT enhances setup precision in proton and carbon ion lung cancer radiotherapy.
- The implementation of SGRT leads to a significant reduction in pre-correction setup errors.
- SGRT provides clinical support for improved patient setup reproducibility in lung particle therapy.
