title: 4D radiobiological modelling of the interplay effect in conventionally and hypofractionated lung tumour IMRT.
abstract: OBJECTIVE
  To study the impact of the interplay between respiration-induced tumour motion and multileaf collimator leaf movements in intensity-modulated radiotherapy (IMRT) as a function of number of fractions, dose rate on population mean tumour control probability ([Formula: see text]) using an in-house developed dose model.
  
  
  METHODS
  Delivered dose was accumulated in a voxel-by-voxel basis inclusive of tumour motion over the course of treatment. The effect of interplay on dose and [Formula: see text] was studied for conventionally and hypofractionated treatments using digital imaging and communications in medicine data sets. Moreover, the effect of dose rate on interplay was also studied for single-fraction treatments. Simulations were repeated several times to obtain [Formula: see text] for each plan.
  
  
  RESULTS
  The average variation observed in mean dose to the target volumes were -0.76% ± 0.36% for the 20-fraction treatment and -0.26% ± 0.68% and -1.05% ± 0.98% for the three- and single-fraction treatments, respectively. For the 20-fraction treatment, the drop in [Formula: see text] was -1.05% ± 0.39%, whereas for the three- and single-fraction treatments, it was -2.80% ± 1.68% and -4.00% ± 2.84%, respectively. By reducing the dose rate from 600 to 300 MU min(-1) for the single-fraction treatments, the drop in [Formula: see text] was reduced by approximately 1.5%.
  
  
  CONCLUSIONS
  The effect of interplay on [Formula: see text] is negligible for conventionally fractionated treatments, whereas considerable drop in [Formula: see text] is observed for the three- and single-fraction treatments. Reduced dose rate could be used in hypofractionated treatments to reduce the interplay effect.
  
  
  CONCLUSIONS
  A novel in silico dose model is presented to determine the impact of interplay effect in IMRT treatments on [Formula: see text].
authors.affiliation: The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, UK.
authors.forename: J
authors.initials: J
authors.lastname: Selvaraj
authors.forename: J
authors.initials: J
authors.lastname: Uzan
authors.forename: C
authors.initials: C
authors.lastname: Baker
authors.forename: A
authors.initials: A
authors.lastname: Nahum
mesh_terms: D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D009038:Motion; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*