Modelling the effects of lung cancer motion due to respiration

Background and objectives: To justify the concept of validating conformal versus intensity-modulated approach in the treatment of non-small cell lung cancer (NSCLC). Materials and methods: For 10 patients representative of the spectrum of tumour sizes and locations, two plans were prepared: one with three-dimensional conformal radiation therapy (3DCRT) technique and the other with intensity-modulated radiation therapy (IMRT) technique. Preliminary measurements were performed in static conditions. For each of the field angles considered, the motion kernel was generated to simulate tumour motion trajectories, with the largest amplitude in the cranio-caudal direction of 4, 6, and 8 mm. The measurement results determined the agreement between the planned and measured doses. Results: No statistically significant differences were found between the motion patterns, with the smallest amplitudes for clinical target volume in 3DCRT. For IMRT, the significant differences between 0 mm vs. 6 mm and 0 mm vs. 8 mm amplitudes were found. The motion impact on delivered vs. planned doses had less effect on the oesophagus in 3DCRT compared to that in IMRT. The observed differences were comparable for the heart. Interpretation and conclusions: For maximal amplitudes below 4 mm, the disagreement between planned and delivered doses can be neglected. However, the amplitudes above 5 mm and 7 mm lead to significant changes in IMRT and 3DCRT dose distribution, respectively.