title: Motion management for radical radiotherapy in non-small cell lung cancer.
abstract: Intrafraction tumour motion is an issue that is of increased interest in the era of image-guided radiotherapy. It is particularly relevant for non-small cell lung cancer, for which a number of recent developments are in use to aid with motion management in the delivery of radical radiotherapy. The ability to deliver hypofractionated ablative doses, such as in stereotactic radiotherapy, has been aided by improvements in the ability to analyse tumour motion and amend treatment delivery. In addition, accounting for tumour motion can enable dose escalation to occur by reducing the normal tissue being irradiated by virtue of a reduction in target volumes. Motion management for lung tumours incorporates five key components: imaging, breath-hold techniques, abdominal compression, respiratory tracking and respiratory gating. These will be described, together with the relevant benefits and associated complexities. Many studies have described improved dosimetric coverage and reduced normal tissue complication probability rates when using motion management techniques. Despite the widespread uptake of many of these techniques, there is a paucity of literature reporting improved outcome in overall survival and local control for patients whenever motion management techniques are used. This overview will review the extent of lung tumour motion, ways in which motion is detected and summarise the key methods used in motion management.
authors.affiliation: Northern Ireland Cancer Centre, Belfast, UK; Centre for Cancer Research and Cell Biology, Queens University, Belfast, UK. Electronic address: coleaidan@hotmail.com.
authors.forename: A J
authors.initials: AJ
authors.lastname: Cole
authors.affiliation: Northern Ireland Cancer Centre, Belfast, UK; Centre for Cancer Research and Cell Biology, Queens University, Belfast, UK.
authors.forename: G G
authors.initials: GG
authors.lastname: Hanna
authors.affiliation: Northern Ireland Cancer Centre, Belfast, UK; Centre for Cancer Research and Cell Biology, Queens University, Belfast, UK.
authors.forename: S
authors.initials: S
authors.lastname: Jain
authors.affiliation: Northern Ireland Cancer Centre, Belfast, UK; Centre for Cancer Research and Cell Biology, Queens University, Belfast, UK.
authors.forename: J M
authors.initials: JM
authors.lastname: O'Sullivan
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D061089:Radiotherapy, Image-Guided
keywords: Four-dimensional computed tomography; gating; motion management; non-small cell lung cancer; radiotherapy; tracking