Intra thoracic anatomical changes in lung cancer patients during the course of radiotherapy.

BACKGROUND AND PURPOSE Conebeam-CT (CBCT) guidance is often used for setup verification of lung cancer patients treated with radiotherapy. The purpose of this study was to quantify intra-thoracic anatomical changes (ITACs) during the radiotherapy treatment and to hand over a decision support system to guide the radiation therapy technologist and radiation oncologist in prioritizing these changes. MATERIALS AND METHODS 1793 CBCT-scans of 177 lung cancer patients treated in 2010 in our institute with radical radiotherapy were evaluated. Our decision support system: "the Traffic Light Protocol", was retrospectively applied to these CBCT-scans. The protocol has four levels: red (immediate action before treatment), orange (action before next fraction), yellow (no action required) and green (no change). RESULTS In 128 patients (72%), 210 ITACs were observed with a maximum level of red, orange and yellow in 12%, 36% and 24% respectively. Types of observed ITACs were, tumor regression (35%), tumor baseline shift (27%), changes in atelectasis (19%), tumor progression (10%), pleural effusion (6%) and infiltrative changes (3%). CONCLUSIONS ITACs have been observed in 72% of all lung cancer patients during the course of radical radiotherapy. The clinical relevance of the proposed ITAC classification in lung radiotherapy needs to be validated in a prospective analysis.