PMID- 26780654 OWN - NLM STAT- MEDLINE DCOM- 20160706 LR - 20181113 IS - 1439-099X (Electronic) IS - 0179-7158 (Linking) VI - 192 IP - 3 DP - 2016 Mar TI - Automatically gated image-guided breath-hold IMRT is a fast, precise, and dosimetrically robust treatment for lung cancer patients. PG - 166-73 LID - 10.1007/s00066-015-0934-z [doi] AB - BACKGROUND: High-dose radiotherapy of lung cancer is challenging. Tumors may move by up to 2 cm in craniocaudal and anteroposterior directions as a function of breathing cycle. Tumor displacement increases with treatment time, which consequentially increases the treatment uncertainty. OBJECTIVE: This study analyzed whether automatically gated cone-beam-CT (CBCT)-controlled intensity modulated fast deep inspiration breath hold (DIBH) stereotactic body radiation therapy (SBRT) in flattening filter free (FFF) technique and normofractionated lung DIBH intensity-modulated radiotherapy (IMRT)/volumetric-modulated arc therapy (VMAT) treatments delivered with a flattening filter can be applied with sufficient accuracy within a clinically acceptable timeslot. MATERIALS AND METHODS: Plans of 34 patients with lung tumors were analyzed. Of these patients, 17 received computer-controlled fast DIBH SBRT with a dose of 60 Gy (5 fractions of 12 Gy or 12 fractions of 5 Gy) in an FFF VMAT technique (FFF-SBRT) every other day and 17 received conventional VMAT with a flattening filter (conv-VMAT) and 2-Gy daily fractional doses (cumulative dose 50-70 Gy). RESULTS: FFF-SBRT plans required more monitor units (MU) than conv-VMAT plans (2956.6 +/- 885.3 MU for 12 Gy/fraction and 1148.7 +/- 289.2 MU for 5 Gy/fraction vs. 608.4 +/- 157.5 MU for 2 Gy/fraction). Total treatment and net beam-on times were shorter for FFF-SBRT plans than conv-VMAT plans (268.0 +/- 74.4 s vs. 330.2 +/- 93.6 s and 85.8 +/- 25.3 s vs. 117.2 +/- 29.6 s, respectively). Total slot time was 13.0 min for FFF-SBRT and 14.0 min for conv-VMAT. All modalities could be delivered accurately despite multiple beam-on/-off cycles and were robust against multiple interruptions. CONCLUSION: Automatically gated CBCT-controlled fast DIBH SBRT in VMAT FFF technique and normofractionated lung DIBH VMAT can be applied with a low number of breath-holds in a short timeslot, with excellent dosimetric accuracy. In clinical routine, these approaches combine optimally reduced lung tissue irradiation with maximal delivery precision for patients with small and larger lung tumors. FAU - Simeonova-Chergou, Anna AU - Simeonova-Chergou A AD - Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. anna.simeonova@gmail.com. FAU - Jahnke, Anika AU - Jahnke A AD - Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. FAU - Siebenlist, Kerstin AU - Siebenlist K AD - Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. FAU - Stieler, Florian AU - Stieler F AD - Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. FAU - Mai, Sabine AU - Mai S AD - Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. FAU - Boda-Heggemann, Judit AU - Boda-Heggemann J AD - Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. FAU - Wenz, Frederik AU - Wenz F AD - Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. FAU - Lohr, Frank AU - Lohr F AD - Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. FAU - Jahnke, Lennart AU - Jahnke L AD - Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. LA - eng PT - Journal Article DEP - 20160115 PL - Germany TA - Strahlenther Onkol JT - Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] JID - 8603469 SB - IM MH - Breath Holding MH - Cone-Beam Computed Tomography/*methods MH - Humans MH - Lung Neoplasms/*diagnostic imaging/*radiotherapy MH - Phantoms, Imaging MH - Radiotherapy Dosage MH - Radiotherapy Planning, Computer-Assisted/methods MH - Radiotherapy, Conformal/*methods MH - Radiotherapy, Image-Guided/*methods MH - Reproducibility of Results MH - Respiratory-Gated Imaging Techniques/*methods MH - Sensitivity and Specificity OTO - NOTNLM OT - Breathing OT - Cone-beam computed tomography OT - Imaging OT - Linear accelerators OT - Quality assurance EDAT- 2016/01/19 06:00 MHDA- 2016/07/07 06:00 CRDT- 2016/01/19 06:00 PHST- 2015/03/20 00:00 [received] PHST- 2015/12/12 00:00 [accepted] PHST- 2016/01/19 06:00 [entrez] PHST- 2016/01/19 06:00 [pubmed] PHST- 2016/07/07 06:00 [medline] AID - 10.1007/s00066-015-0934-z [pii] AID - 10.1007/s00066-015-0934-z [doi] PST - ppublish SO - Strahlenther Onkol. 2016 Mar;192(3):166-73. doi: 10.1007/s00066-015-0934-z. Epub 2016 Jan 15.