title: Impact of target reproducibility on tumor dose in stereotactic radiotherapy of targets in the lung and liver.
abstract: OBJECTIVE
  Previous analyses of target reproducibility in extracranial stereotactic radiotherapy have revealed standard security margins for planning target volume (PTV) definition of 5mm in axial and 5-10mm in longitudinal direction. In this study the reproducibility of the clinical target volume (CTV) of lung and liver tumors within the PTV over the complete course of hypofractionated treatment is evaluated. The impact of target mobility on dose to the CTV is assessed by dose-volume histograms (DVH).
  
  
  METHODS
  Twenty-two pulmonary and 21 hepatic targets were treated with three stereotactic fractions of 10 Gy to the PTV-enclosing 100%-isodose with normalization to 150% at the isocenter. A conformal dose distribution was related to the PTV, which was defined by margins of 5-10mm added to the CTV. Prior to each fraction a computed tomography (CT)-simulation over the complete target volume was performed resulting in a total of 60 CT-simulations for lung and 58 CT-simulations for hepatic targets. The CTV from each CT-simulation was segmented and matched with the CT-study used for treatment planning. A DVH of the simulated CTV was calculated for each fraction. The target coverage (TC) of dose to the simulated CTV was defined as the proportion of the CTV receiving at least the reference dose (100%).
  
  
  RESULTS
  A decrease of TC to <95% was found in 3/60 simulations (5%) of pulmonary and 7/58 simulations (12%) of hepatic targets. In two of 22 pulmonary targets (9%) and in four of 21 hepatic targets (19%) a TC of <95% occurred in at least one fraction. At risk for a decreased TC <95% were pulmonary targets with increased breathing mobility and hepatic targets with a CTV exceeding 100 cm(3).
  
  
  CONCLUSIONS
  Target reproducibility was precise within the reference isodose in 91% of lung and 81% of liver tumors with a TC of the complete CTV >or=95% at each fraction of treatment. Pulmonary targets with increased breathing mobility and liver tumors >100 cm(3) are at risk for target deviation exceeding the standard security margins for PTV-definition at least for one fraction and require individual evaluation of sufficient margins.
authors.affiliation: Department of Radiotherapy, University of Würzburg, Josef-Schneider-Strasse 11, D-97080 Würzburg, Germany.
authors.forename: Jörn
authors.initials: J
authors.lastname: Wulf
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hädinger
authors.forename: Ulrich
authors.initials: U
authors.lastname: Oppitz
authors.forename: Wibke
authors.initials: W
authors.lastname: Thiele
authors.forename: Michael
authors.initials: M
authors.lastname: Flentje
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011880:Radiotherapy Planning, Computer-Assisted; D015203:Reproducibility of Results; D013238:Stereotaxic Techniques; D016896:Treatment Outcome