MLC tracking for lung SABR is feasible, efficient and delivers high-precision target dose and lower normal tissue dose.

Booth, J; Caillet, V; Briggs, A; Hardcastle, N; Angelis, G; Jayamanne, D; Shepherd, M; Podreka, A; Szymura, K; Nguyen, DT; Poulsen, P; O'Brien, R; Harris, B; Haddad, C; Eade, T; Keall, P

MLC tracking for lung SABR is feasible, efficient and delivers high-precision target dose and lower normal tissue dose.

Booth, J Caillet, V Briggs, A Hardcastle, N Angelis, G Jayamanne, D Shepherd, M Podreka, A Szymura, K Nguyen, DT Poulsen, P O'Brien, R Harris, B Haddad, C Eade, T Keall, P

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Publisher:: Elsevier BV
Publication Type:: Journal Article
Citation:: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2020, 155, pp. 131-137
Issue Date:: 2020-11-03

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Field	Value	Language
dc.contributor.author	Booth, J
dc.contributor.author	Caillet, V
dc.contributor.author	Briggs, A
dc.contributor.author	Hardcastle, N
dc.contributor.author	Angelis, G
dc.contributor.author	Jayamanne, D
dc.contributor.author	Shepherd, M
dc.contributor.author	Podreka, A
dc.contributor.author	Szymura, K
dc.contributor.author	Nguyen, DT
dc.contributor.author	Poulsen, P
dc.contributor.author	O'Brien, R
dc.contributor.author	Harris, B
dc.contributor.author	Haddad, C
dc.contributor.author	Eade, T
dc.contributor.author	Keall, P
dc.date.accessioned	2021-03-07T03:02:33Z
dc.date.available	2020-10-24
dc.date.available	2021-03-07T03:02:33Z
dc.date.issued	2020-11-03
dc.identifier.citation	Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2020, 155, pp. 131-137
dc.identifier.issn	0167-8140
dc.identifier.issn	1879-0887
dc.identifier.uri	http://hdl.handle.net/10453/146839
dc.description.abstract	<h4>Background and purpose</h4>The purpose of this work is to present the clinical experience from the first-in-human trial of real-time tumor targeting via MLC tracking for stereotactic ablative body radiotherapy (SABR) of lung lesions.<h4>Methods and materials</h4>Seventeen patients with stage 1 non-small cell lung cancer (NSCLC) or lung metastases were included in a study of electromagnetic transponder-guided MLC tracking for SABR (NCT02514512). Patients had electromagnetic transponders inserted near the tumor. An MLC tracking SABR plan was generated with planning target volume (PTV) expanded 5 mm from the end-exhale gross tumor volume (GTV). A clinically approved comparator plan was generated with PTV expanded 5 mm from a 4DCT-derived internal target volume (ITV). Treatment was delivered using a standard linear accelerator to continuously adapt the MLC based on transponder motion. Treated volumes and reconstructed delivered dose were compared between MLC tracking and comparator ITV-based treatment.<h4>Results</h4>All seventeen patients were successfully treated with MLC tracking (70 successful fractions). MLC tracking treatment delivery time averaged 8 minutes. The time from the start of CBCT to the end of treatment averaged 22 minutes. The MLC tracking PTV for 16/17 patients was smaller than the ITV-based PTV (range -1.6% to 44% reduction, or -0.6 to 18 cc). Reductions in mean lung dose (27 cGy) and V20Gy (50 cc) were statistically significant (p < 0.02). Reconstruction of treatment doses confirmed a statistically significant improvement in delivered GTV D98% (p < 0.05) from planned dose compared with the ITV-based plans.<h4>Conclusion</h4>The first treatments with lung MLC tracking have been successfully performed in seventeen SABR patients. MLC tracking for lung SABR is feasible, efficient and delivers high-precision target dose and lower normal tissue dose.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier BV
dc.relation.ispartof	Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
dc.relation.isbasedon	10.1016/j.radonc.2020.10.036
dc.rights	Elsevier required licence: © 2020 . This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/. The definitive publisher version is available online at https://doi.org/10.1016/j.radonc.2020.10.036	en_US
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	0299 Other Physical Sciences, 1112 Oncology and Carcinogenesis
dc.subject.classification	Oncology & Carcinogenesis
dc.title	MLC tracking for lung SABR is feasible, efficient and delivers high-precision target dose and lower normal tissue dose.
dc.type	Journal Article
utslib.citation.volume	155
utslib.location.activity	Ireland
utslib.for	0299 Other Physical Sciences
utslib.for	1112 Oncology and Carcinogenesis
pubs.organisational-group	/University of Technology Sydney/Faculty of Engineering and Information Technology
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney/Faculty of Engineering and Information Technology/School of Biomedical Engineering
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	open_access	*
dc.date.updated	2021-03-07T03:02:31Z
pubs.publication-status	Published
pubs.volume	155

Abstract:

Background and purpose

The purpose of this work is to present the clinical experience from the first-in-human trial of real-time tumor targeting via MLC tracking for stereotactic ablative body radiotherapy (SABR) of lung lesions.

Methods and materials

Seventeen patients with stage 1 non-small cell lung cancer (NSCLC) or lung metastases were included in a study of electromagnetic transponder-guided MLC tracking for SABR (NCT02514512). Patients had electromagnetic transponders inserted near the tumor. An MLC tracking SABR plan was generated with planning target volume (PTV) expanded 5 mm from the end-exhale gross tumor volume (GTV). A clinically approved comparator plan was generated with PTV expanded 5 mm from a 4DCT-derived internal target volume (ITV). Treatment was delivered using a standard linear accelerator to continuously adapt the MLC based on transponder motion. Treated volumes and reconstructed delivered dose were compared between MLC tracking and comparator ITV-based treatment.

Results

All seventeen patients were successfully treated with MLC tracking (70 successful fractions). MLC tracking treatment delivery time averaged 8 minutes. The time from the start of CBCT to the end of treatment averaged 22 minutes. The MLC tracking PTV for 16/17 patients was smaller than the ITV-based PTV (range -1.6% to 44% reduction, or -0.6 to 18 cc). Reductions in mean lung dose (27 cGy) and V20Gy (50 cc) were statistically significant (p < 0.02). Reconstruction of treatment doses confirmed a statistically significant improvement in delivered GTV D98% (p < 0.05) from planned dose compared with the ITV-based plans.

Conclusion

The first treatments with lung MLC tracking have been successfully performed in seventeen SABR patients. MLC tracking for lung SABR is feasible, efficient and delivers high-precision target dose and lower normal tissue dose.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/146839