Influence of different treatment techniques and clinical factors over the intrafraction variation on lung stereotactic body radiotherapy.

Abstract

In the present study we compared three different Stereotactic body radiation therapy (SBRT) treatment delivery techniques in terms of treatment time (TT) and their relation with intrafraction variation (IFV). Besides that, we analyzed if different clinical factors could have an influence on IFV. Finally, we appreciated the soundness of our margins. Forty-five patients undergoing SBRT for stage I lung cancer or lung metastases up to 5cm were included in the study. All underwent 4DCT scan to create an internal target volume (ITV) and a 5mm margin was added to establish the planning target volume (PTV). Cone-beam CTs (CBCTs) were acquired before and after each treatment to quantify the IFV. Three different treatment delivery techniques were employed: fixed fields (FF), dynamically collimated arcs (AA) or a combination of both (FA). We studied if TT was different among these modalities of SBRT and whether TT and IFV were correlated. Clinical data related to patients and tumors were recorded as potential influential factors over the IFV. A total of 52 lesions and 147 fractions were analyzed. Mean IFV for x-, y- and z-axis were 1±1.16mm, 1.29±1.38mm and 1.17±1.08mm, respectively. Displacements were encompassed by the 5mm margin in 96.1% of fractions. TT was significantly longer in FF therapy (24.76±5.4min), when compared with AA (15.30±3.68min) or FA (17.79±3.52min) (p<0.001). Unexpectedly, IFV did not change significantly between them (p=0.471). Age (p=0.003) and left vs. right location (p=0.005) were related to 3D shift ≥2mm. In the multivariate analysis only age showed a significant impact on the IFV (OR=1.07, p=0.007). The choice of AA, FF or FA does not impact on IFV although FF treatment takes significantly longer treatment time. Our immobilization device offers enough accuracy and the 5mm margin may be considered acceptable as it accounts for more than 95% of tumor shifts. Age is the only clinical factor that influenced IFV significantly in our analysis.