title: Respiratory-driven lung tumor motion is independent of tumor size, tumor location, and pulmonary function.
abstract: OBJECTIVE
  To determine whether superior-inferior lung tumor motion is predictable by tumor size or location, or pulmonary function test results.
  
  
  METHODS
  Superior-inferior tumor motion was measured on orthogonal radiographs taken during simulation of 22 patients with inoperable lung cancer diagnosed by orthogonal radiographs.
  
  
  RESULTS
  The tumor size averaged 5.5 +/- 3.1 cm (range 1.5-12 cm). Seven of 11 central tumors demonstrated some motion compared with 5 of 11 peripheral tumors. Four of 5 upper lobe tumors moved compared with 8 of 17 tumors that were either middle or lower lobe lesions. The mean fourth rib motion was 7.3 +/- 3.2 mm (range 2-15). The mean FeV(1) was 1.8 +/- 1.2 (range 0.55-5.33. The mean diffusing capacity of the lung for carbon monoxide was 14.0 +/- 6.5 (range 7.8-21.9). The mean total lung capacity was 6.5 +/- 1.2 (range 3.3-8.4). None of these parameters correlated with tumor motion. Although lateral tumor motion could not be consistently determined, 1 tumor moved 10 mm anterior-posteriorly.
  
  
  CONCLUSIONS
  Lung tumors often move significantly during respiration. Tumor motion is not predictable by tumor size or location, or pulmonary function test results. Therefore, tumor motion must be measured in all patients. Measurement in three dimensions will likely be necessary to maximize the irradiated lung volumes or choose beam arrangements parallel to the major axis of motion.
authors.affiliation: Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. cstevens@mdanderson.org
authors.forename: C W
authors.initials: CW
authors.lastname: Stevens
authors.forename: R F
authors.initials: RF
authors.lastname: Munden
authors.forename: K M
authors.initials: KM
authors.lastname: Forster
authors.forename: J F
authors.initials: JF
authors.lastname: Kelly
authors.forename: Z
authors.initials: Z
authors.lastname: Liao
authors.forename: G
authors.initials: G
authors.lastname: Starkschall
authors.forename: S
authors.initials: S
authors.lastname: Tucker
authors.forename: R
authors.initials: R
authors.lastname: Komaki
mesh_terms: D000328:Adult; D000368:Aged; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D008875:Middle Aged; D009068:Movement; D009367:Neoplasm Staging; D011653:Pulmonary Diffusing Capacity; D011859:Radiography; D012119:Respiration