The irregular breathing effect on target volume and coverage for lung stereotactic body radiotherapy

The major challenge in treating a mobile target is obtaining the temporal and spatial information imaging and treatment details. This phantom study quantitatively evaluates the geometric and dosimetric effects of various treatment techniques under different respiratory patterns. The regular motion model was a sinusoidal waveform with a longitudinal range of ±1.5 cm and a period of 4 sec, while irregular motion models were generated by extracting signals from clinical cases. Helical CT for a static target and 4D CT with retrospective sorting were acquired. Phase bin, maximum, and average intensity projection (MIP and AIP) CT datasets were reconstructed. RapidArc and IMRT plans were generated on static and moving target CT datasets with different motion patterns using the phase-based gating and nongating treatment. Dose measurements were performed using EBT3 films. Dose profile and gamma analysis (±3%/1 mm criteria) were used for dose comparisons. For the irregular motions, internal target volume variations between AIP and MIP datasets (AIP/MIP) had slight differences (−6.2% to −7.7%) for gated plans, and larger differences (−12.3% to −15.2%) for nongated plans. Dosimetric measurements showed a high gamma passing rate (>98.5%) for the static plan in the target region, while the AIP and MIP gated plans had average passing rates of 92.2% ± 5.7% and 85.8% ± 9.5%, respectively. Nongated plans had significantly lower and deviated passing rates, while the AIP and MIP plans had passing rates of 43.6% ± 22.2% and 66.7% ± 28.2%, respectively (p < 0.05). Lung stereotactic body radiotherapy treatment delivered with the gated technique did not compromise the gross tumor volumes coverage, and was insensitive to the breathing irregularities and plan techniques. Adequate margins should be accounted to cover the mis-gating effect when using the phase-based gating under irregular motion.