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. 2021 Oct 12;13(20):5092.
doi: 10.3390/cancers13205092.

Potential Morbidity Reduction for Lung Stereotactic Body Radiation Therapy Using Respiratory Gating

Kim Melanie Kraus  1   2 , Cristoforo Simonetto  2 , Pavel Kundrát  3 , Vanessa Waitz  1 , Kai Joachim Borm  1 , Stephanie Elisabeth Combs  1   2   4
Affiliations

Potential Morbidity Reduction for Lung Stereotactic Body Radiation Therapy Using Respiratory Gating

Kim Melanie Kraus et al. Cancers (Basel). .

Abstract

We investigated the potential of respiratory gating to mitigate the motion-caused misdosage in lung stereotactic body radiotherapy (SBRT). For fourteen patients with lung tumors, we investigated treatment plans for a gating window (GW) including three breathing phases around the maximum exhalation phase, GW40-60. For a subset of six patients, we also assessed a preceding three-phase GW20-40 and six-phase GW20-70. We analyzed the target volume, lung, esophagus, and heart doses. Using normal tissue complication probability (NTCP) models, we estimated radiation pneumonitis and esophagitis risks. Compared to plans without gating, GW40-60 significantly reduced doses to organs at risk without impairing the tumor doses. On average, the mean lung dose decreased by 0.6 Gy (p < 0.001), treated lung V20Gy by 2.4% (p = 0.003), esophageal dose to 5cc by 2.0 Gy (p = 0.003), and maximum heart dose by 3.2 Gy (p = 0.009). The model-estimated mean risks of 11% for pneumonitis and 12% for esophagitis without gating decreased upon GW40-60 to 7% and 9%, respectively. For the highest-risk patient, gating reduced the pneumonitis risk from 43% to 32%. Gating is most beneficial for patients with high-toxicity risks. Pre-treatment toxicity risk assessment may help optimize patient selection for gating, as well as GW selection for individual patients.

Keywords: SBRT; lung cancer; motion management; radiation toxicity; radiotherapy treatment planning.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Boxplots showing the distribution of individual differences between the application of a GW40–60 compared to no gating. Boxes show interquartile ranges with the median denoted by a separating line. Outliers are marked by circles and patient case numbers.
Figure 2
Figure 2
Boxplots showing the distribution of individual differences among the application of different gating windows. In each panel, the left part depicted in green represents the difference between plans with a gating window of 20–40 compared to 40–60. The right, brown part corresponds to the difference between a gating window of 20–70 and 40–60. Boxes show interquartile ranges with the median denoted by a separating line. Outliers are marked by circles and patient case numbers.
Figure 3
Figure 3
Left: Changes in dosimetric parameters for different GWs for a subset of 6 patients. Blue bars refer to the differences between GW40–60 compared to no gating; green bars refer to differences between GW20–40 compared to no gating; brown bars refer to the differences between GW20–70 to no gating. Right: Dosimetric changes between GW40–60 and no gating for the residual 8 patients.
Figure 4
Figure 4
Absolute reduction in estimated radiation pneumonitis risk (left) and esophagitis risk (right) as a function of estimated risk of SBRT without gating. For the gating plans, a window of 40–60 was applied. Each symbol represents one patient case as indicated with numbers next to the symbol. Red color (+ symbols) indicates central tumors, and blue color (× symbols) indicates peripheral tumors. Grey lines indicate the mean risk reductions of 36% for pneumonitis and 23% for esophagitis.
See this image and copyright information in PMC

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