Reproducibility of target volumes generated using uncoached 4-dimensional CT scans for peripheral lung cancer

Background: 4-dimensional CT (4DCT) scans are increasingly used to account for mobility during radiotherapy planning. As variations in respiratory patterns can alter observed motion, with consequent changes in the generated target volumes, we evaluated the reproducibility of 4D target volumes generated during repeat uncoached quiet respiration. Methods: A retrospective analysis was performed on two successive scans (4DCT1 and 4DCT2) generated at the same scanning session for 26 patients with peripheral lung cancer treated with stereotactic radiotherapy (SRT). The volume and position of planning target volumes (PTV4DCT1 and PTV4DCT2) contoured on both scans were compared, and a dosimetric analysis performed. A SRT plan optimized for each PTV was sequentially applied to the other PTV, and coverage by the 80% isodose was evaluated. Color intensity projections (CIP) were used to evaluate regions of underdosage. Results: No significant volumetric differences were observed between the two PTVs (t-Test p = 0.60). The average displacement of the center of mass between corresponding PTVs was 1.4 +/- 1.0 mm, but differences in position were 2.0 mm or greater in 5 cases (19%). Coverage of both PTVs by the 80% prescription isodose exceeded 90% for all but one patient. For the latter, the prescription isodose covered only 82.5% of PTV4DCT1. CIP analysis revealed that the region of underdosage was an end-inspiratory position occupied by the tumor for only 10-20% of the respiratory cycle. Conclusion: In nearly all patients with stage I lung cancer, the PTV derived from a single uncoached 4DCT achieves dosimetric coverage that is similar to that achieved using two such consecutive scans.