Dosimetric robustness of lung tumor photon radiotherapy evaluated from multiple event CT imaging.

Intrafractional respiratory motion is a concern for lung tumor radiotherapy but full evaluation of its impact is hampered by the lack of images representing the true motion. This study presents a novel evaluation using free-breathing images acquired over realistic treatment times to study the dosimetric impact of respiratory motion in photon radiotherapy. Cine-CT images of 14 patients with lung cancer acquired during eight minutes of free-breathing at three occasions were used to simulate dose tracking of four different planning methods. These methods aimed to deliver 54 Gy in three fractions to D Despite tumor motion amplitudes being larger than in the 4DCT all but FLU achieved the intended CTV D Tumor motion in free-breathing not covered by the 4DCT had a small impact on dose. The RB4 is recommended for planning of free-breathing treatments. No factor was found that consistently correlated dose degradation with patient or motion attributes.

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Copyright © 2022 Associazione Italiana di Fisica Medica e Sanitaria. Published by Elsevier Ltd. All rights reserved.

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Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.