title: Benefit of three-dimensional image-guided stereotactic localization in the hypofractionated treatment of lung cancer.
abstract: OBJECTIVE
  The aim of this study was to investigate the benefit of image-guided stereotactic localization in the hypofractionated treatment for medically inoperable non-small-cell lung cancer.
  
  
  METHODS
  A stereotactic body localizer (SBL) system was used for patient immobilization, reliable image registration among multiphase computed tomography (CT) scanning, and image-guided stereotactic localization. Three sets of CT scans were taken (free breathing, and breath holding at the end-tidal inspiration and expiration, respectively) to contrast target motion. Target delineation was performed on all 3 sets of images and the combination of the targets forms an internal target volume (ITV). In this retrospective study of treatment dose verification, we performed image fusion between the simulation CT scan and each pretreatment CT scan to obtain the same target and critical structure information. The same treatment plans were reloaded onto each pretreatment CT scan with their respective stereotactic coordinate system. The changes in dose distributions were assessed by dose-volume histograms of the planning target volume (PTV) and the critical structures before and after isocenter corrections which were prompted by image-guided stereotactic localization. We compared D95, D99, and V95 for the PTV and internal target volume, and V20 and V30 for the ipsilateral lung.
  
  
  RESULTS
  Our retrospective study for 10 patients with 40 dose reconstructions showed that the average D95, D99, and V95 of the PTVs are 92.1%, 88.1%, and 95.8% of the planned values before isocenter corrections. With the corrections, all of these values are improved to 100% of the planned values.
  
  
  CONCLUSIONS
  Three-dimensional image guidance is crucial for stereotactic radiotherapy of lung tumors.
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA. lu.wang@fccc.edu
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.forename: Steve
authors.initials: S
authors.lastname: Feigenberg
authors.forename: Lili
authors.initials: L
authors.lastname: Chen
authors.forename: Kamen
authors.initials: K
authors.lastname: Pasklev
authors.forename: Charlie C-M
authors.initials: CC
authors.lastname: Ma
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007103:Immobilization / Q000379:methods*; D008175:Lung Neoplasms / Q000532:radiotherapy*; D011829:Radiation Dosage; D011879:Radiotherapy Dosage; D011881:Radiotherapy, Computer-Assisted / Q000379:methods*; D012119:Respiration; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed