title: Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy.
abstract: Physicians considering stereotactic ablative body radiation therapy (SBRT) for the treatment of extracranial cancer targets must be aware of the sizeable risks for normal tissue injury and the hazards of physical tumor miss. A first-of-its-kind SBRT platform achieves high-precision ablative radiation treatment through a combination of versatile real-time imaging solutions and sophisticated tumor tracking capabilities. It uses dual-diagnostic kV x-ray units for stereoscopic open-loop feedback of cancer target intrafraction movement occurring as a consequence of respiratory motions and heartbeat. Image-guided feedback drives a gimbaled radiation accelerator (maximum 15 x 15 cm field size) capable of real-time ±4 cm pan-and-tilt action. Robot-driven ±60° pivots of an integrated ±185° rotational gantry allow for coplanar and non-coplanar accelerator beam set-up angles, ultimately permitting unique treatment degrees of freedom. State-of-the-art software aids real-time six dimensional positioning, ensuring irradiation of cancer targets with sub-millimeter accuracy (0.4 mm at isocenter). Use of these features enables treating physicians to steer radiation dose to cancer tumor targets while simultaneously reducing radiation dose to normal tissues. By adding respiration correlated computed tomography (CT) and 2-[(18)F] fluoro-2-deoxy-ᴅ-glucose ((18)F-FDG) positron emission tomography (PET) images into the planning system for enhanced tumor target contouring, the likelihood of physical tumor miss becomes substantially less. In this article, we describe new radiation plans for the treatment of moving lung tumors.
authors.affiliation: Department of Radiation Oncology, Summa Cancer Institute; kunosc@summahealth.org.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Kunos
authors.affiliation: Department of Radiation Oncology, Summa Cancer Institute.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Fabien
authors.affiliation: Department of Radiation Oncology, Summa Cancer Institute.
authors.forename: John P
authors.initials: JP
authors.lastname: Shanahan
authors.affiliation: Department of Radiation Oncology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel.
authors.forename: Christine
authors.initials: C
authors.lastname: Collen
authors.affiliation: Department of Radiation Oncology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel.
authors.forename: Thierry
authors.initials: T
authors.lastname: Gevaert
authors.affiliation: Department of Radiation Oncology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Poels
authors.affiliation: Department of Radiation Oncology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel.
authors.forename: Robbe
authors.initials: R
authors.lastname: Van den Begin
authors.affiliation: Department of Radiation Oncology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Engels
authors.affiliation: Department of Radiation Oncology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel.
authors.forename: Mark
authors.initials: M
authors.lastname: De Ridder
mesh_terms: D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18